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目的了解上海地区社区获得性肺炎病原的分布和耐药情况,为经验治疗提供依据。方法对2岁以上的389例社区获得性肺炎患者留取痰标本进行细菌培养和药物敏感试验,并采用DNA检测、血清学方法和尿抗原测定检测非典型病原。结果155例患者病原检测阳性,其中28例为混合感染。病原菌共123株,主要为嗜血杆菌属、肺炎链球菌和克雷伯菌属。非典型病原阳性61例,主要为肺炎支原体。嗜血杆菌属细菌产酶率为7.8%,对阿奇霉素、头孢呋辛等所测抗菌药物均呈敏感。肺炎链球菌中多为青霉素敏感株,对头孢曲松、左氧氟沙星和万古霉素则全部呈现敏感。结论嗜血杆菌属仍是社区获得性肺炎的主要病原之一,非典型病原亦占重要地位。青霉素和阿莫西林仍可作经验用药,在青霉素不敏感肺炎链球菌流行地区可增大剂量,或改用第二、三代头孢菌素。新大环内酯类和新氟喹诺酮类亦可作为经验用药之一。
Objective To understand the distribution and drug resistance of community-acquired pneumonia in Shanghai and provide the basis for empirical treatment. Methods Bacterial cultures and drug sensitivity tests were performed on 389 patients with acquired pneumonia who were over 2 years of age with sputum samples. The atypical pathogens were detected by DNA test, serological test and urine antigen test. Results 155 patients were positive for pathogen detection, of which 28 were mixed infection. A total of 123 pathogenic bacteria, mainly Haemophilus, Streptococcus pneumoniae and Klebsiella. Atypical pathogenic positive in 61 cases, mainly Mycoplasma pneumoniae. Haemophilus bacterial enzyme production rate was 7.8%, azithromycin, cefuroxime and other antimicrobial agents were sensitive. Streptococcus pneumoniae mostly penicillin-sensitive strains of ceftriaxone, levofloxacin and vancomycin are all sensitive. Conclusion Haemophilus is still one of the major pathogens of community-acquired pneumonia, and atypical pathogens also play an important role. Penicillin and amoxicillin can still be used for empirical medicine, in the penicillin-insensitive Streptococcus pneumoniae endemic areas can increase the dose, or switch to the second and third generation cephalosporins. New macrolides and new fluoroquinolones can also be used as one of the empirical medication.