社区获得性肺炎患者病原微生物特征
|
摘要
目的 研究社区获得性肺炎患者病原微生物分布情况。方法 选择2017年1月至2018年1月在本院急诊科治疗的确诊为社区获得性肺炎(CAP)的患者257例,采用自行设计的调查表研究患者基本资料,收集患者痰标本和血液标本进行微生物检测。结果 入选患者中年龄≥60岁者比例明显高于18～44岁及45～59岁患者。年龄≥60岁的患者中高血压、冠心病、糖尿病、COPD、肾功能不全、入院前抗生素使用、BMI≤18.5,CURB-65≥2的比例明显高于18～44岁及45～59岁患者。嗜肺军团菌(11.28%)是患者最常见的病原体,其次为流感病毒(10.51%)。其余检出病原体为铜绿假单胞菌(9.34%)、大肠埃希菌(8.95%)、金黄色葡萄球菌(8.56%)、支原体(5.84%)、鲍曼不动杆菌(5.06%)、肺炎衣原体(5.06%)、阴沟肠杆菌(2.72%)、克雷伯杆菌(2.72%)、肺炎链球菌(2.72%),嗜麦芽假单胞菌(2.33%)、产气肠杆菌(1.17%)、流感嗜血杆菌(0.78%)、溶血链球菌(0.39%)。≥60岁患者中嗜肺军团菌、流感病毒、铜绿假单胞菌、大肠埃希菌、鲍曼不动杆菌感染的比例明显高于18～44岁及45～59岁患者。结论 CAP主要发病于60岁以上的患者,糖尿病、高血压、肾功能不全等合并症可能是CAP的危险因素。嗜肺军团菌、流感病毒、大肠埃希菌、铜绿假单胞菌、支原体、鲍曼不动杆菌等是CAP的主要病原微生物。
Objective To explore the distribution of pathogenic microbes in patients with community-acquired pneumonia(CAP). Methods 257 patients with CAP diagnosed in the emergency department of our hospital from January 2017 to January 2018 were enrolled. The self-designed questionnaire was used to collect the basic data of patients, and specimens of patient sputum and blood were collected for microbiological examination. Results The ratio of patients aged ≥60 years was significantly higher than those aged 18-44 years and 45-59 years. In age ≥60 group, the ratios of hypertension, coronary heart disease, diabetes, COPD, renal insufficiency, antibiotic use before admission, BMI≤18.5 and CURB-65≥2 were significantly higher than those aged 18-44 years and 45-59 years respectively. Legionella pneumophila(11.28%) was the most common pathogen, followed by influenza virus(10.51%), Pseudomonas aeruginosa(9.34%), Escherichia coli(8.95%), Staphylococcus aureus(8.56%), Mycoplasma(5.84%), Acinetobacter baumannii(5.06%), Chlamydia pneumoniae(5.06%), Enterobacter cloacae(2.72%), Klebsiella(2.72%), Streptococcus pneumoniae(2.72%), Pseudomonas maltophilia(2.33%), Enterobacter aerogenes(1.17%), Haemophilus influenzae(0.78%) and Streptococcus hemolyticus(0.39%). The rates of Legionella pneumophila, influenza virus, Pseudomonas aeruginosa, Escherichia coli and Acinetobacter baumannii infection in patients ≥60 years were significantly higher than in those aged 18-44 and 45-59 years respectively. Conclusion The incidence of CAP is higher in elderly patients aged ≥60 years. Complications such as diabetes, hypertension and renal insufficiency are potentially the risk factors of CAP. Legionella pneumophila, influenza virus and Escherichia coli are the main pathogens of CAP.
Objective To explore the distribution of pathogenic microbes in patients with community-acquired pneumonia(CAP). Methods 257 patients with CAP diagnosed in the emergency department of our hospital from January 2017 to January 2018 were enrolled. The self-designed questionnaire was used to collect the basic data of patients, and specimens of patient sputum and blood were collected for microbiological examination. Results The ratio of patients aged ≥60 years was significantly higher than those aged 18-44 years and 45-59 years. In age ≥60 group, the ratios of hypertension, coronary heart disease, diabetes, COPD, renal insufficiency, antibiotic use before admission, BMI≤18.5 and CURB-65≥2 were significantly higher than those aged 18-44 years and 45-59 years respectively. Legionella pneumophila(11.28%) was the most common pathogen, followed by influenza virus(10.51%), Pseudomonas aeruginosa(9.34%), Escherichia coli(8.95%), Staphylococcus aureus(8.56%), Mycoplasma(5.84%), Acinetobacter baumannii(5.06%), Chlamydia pneumoniae(5.06%), Enterobacter cloacae(2.72%), Klebsiella(2.72%), Streptococcus pneumoniae(2.72%), Pseudomonas maltophilia(2.33%), Enterobacter aerogenes(1.17%), Haemophilus influenzae(0.78%) and Streptococcus hemolyticus(0.39%). The rates of Legionella pneumophila, influenza virus, Pseudomonas aeruginosa, Escherichia coli and Acinetobacter baumannii infection in patients ≥60 years were significantly higher than in those aged 18-44 and 45-59 years respectively. Conclusion The incidence of CAP is higher in elderly patients aged ≥60 years. Complications such as diabetes, hypertension and renal insufficiency are potentially the risk factors of CAP. Legionella pneumophila, influenza virus and Escherichia coli are the main pathogens of CAP.
引文
[1] 中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):253-279.
[2] LIU Youning,ZHAO Tiemei,YAO Wanzhen,et al.Prevalence of atypical pathogens in adult patients with community-acquired pneumonia in Beijing[J].Chin J Tuberc Respir Dis,2004,27(1):27-30.(in Chinese) 刘又宁,赵铁梅,姚婉贞,等.北京地区成人社区获得性肺炎非典型病原体流行病学调查[J].中华结核和呼吸杂志,2004,27(1):27-30.
[3] Peto L,Nadjm B,Horby P,et al.The bacterial aetiology of adult community-acquired pneumonia in Asia:A systematic review[J].Trans R Soc Trop Med Hyg,2014,108(6):326-337.
[4] 邓伟吾.社区获得性肺炎诊断和治疗指南[C]//中华医学会第七次全国感染病学术会议论文汇编,上海:中华医学会,2001:28-30.
[5] 尚红,王毓三,申子瑜.全国临床检验操作规程[M].北京:人民卫生出版社,2015:636.
[6] Collaborators GL.Estimates of the global,regional,and national morbidity,mortality,and aetiologies of lower respiratory tract infections in 195 countries:A systematic analysis for the Global Burden of Disease Study 2015[J].Lancet Infect Dis,2017,17(11):1133-1161.
[7] Mandell LA,Wunderink RG,Anzueto A,et al.Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults[J].Clin Infect Dis,2007,44(Suppl 2):S27-S72.
[8] Koul P,Khan U,Bhat K,et al.Recrudescent wave of A/H1N1pdm09 influenza viruses in winter 2012-2013 in Kashmir,India[J].PLoS Curr,2013,doi:10.1371/currents.outbreaks.f1241c3a2625fc7a81bf25eea81f66e6.
[9] Koul PA,Mir H,Akram S,et al.Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease[J].Lung India,2017,34(1):29-33.
[10] Huijskens EG,van Erkel AJ,Palmen FM,et al.Viral and bacterial aetiology of community-acquired pneumonia in adults[J].Influenza Other Respir Viruses,2013,7(4):567-573.
[2] LIU Youning,ZHAO Tiemei,YAO Wanzhen,et al.Prevalence of atypical pathogens in adult patients with community-acquired pneumonia in Beijing[J].Chin J Tuberc Respir Dis,2004,27(1):27-30.(in Chinese) 刘又宁,赵铁梅,姚婉贞,等.北京地区成人社区获得性肺炎非典型病原体流行病学调查[J].中华结核和呼吸杂志,2004,27(1):27-30.
[3] Peto L,Nadjm B,Horby P,et al.The bacterial aetiology of adult community-acquired pneumonia in Asia:A systematic review[J].Trans R Soc Trop Med Hyg,2014,108(6):326-337.
[4] 邓伟吾.社区获得性肺炎诊断和治疗指南[C]//中华医学会第七次全国感染病学术会议论文汇编,上海:中华医学会,2001:28-30.
[5] 尚红,王毓三,申子瑜.全国临床检验操作规程[M].北京:人民卫生出版社,2015:636.
[6] Collaborators GL.Estimates of the global,regional,and national morbidity,mortality,and aetiologies of lower respiratory tract infections in 195 countries:A systematic analysis for the Global Burden of Disease Study 2015[J].Lancet Infect Dis,2017,17(11):1133-1161.
[7] Mandell LA,Wunderink RG,Anzueto A,et al.Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults[J].Clin Infect Dis,2007,44(Suppl 2):S27-S72.
[8] Koul P,Khan U,Bhat K,et al.Recrudescent wave of A/H1N1pdm09 influenza viruses in winter 2012-2013 in Kashmir,India[J].PLoS Curr,2013,doi:10.1371/currents.outbreaks.f1241c3a2625fc7a81bf25eea81f66e6.
[9] Koul PA,Mir H,Akram S,et al.Respiratory viruses in acute exacerbations of chronic obstructive pulmonary disease[J].Lung India,2017,34(1):29-33.
[10] Huijskens EG,van Erkel AJ,Palmen FM,et al.Viral and bacterial aetiology of community-acquired pneumonia in adults[J].Influenza Other Respir Viruses,2013,7(4):567-573.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |