Community-acquired pneumonia in Shanghai, China: microbial etiology and implications for empirical therapy in a prospective study of 389 patients
Community-acquired pneumonia in Shanghai, China: microbial etiology and implications for empirical therapy in a prospective study of 389 patients
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DOI：
10.1007/s10096-006-0146-7
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发表时间：
2006-06-01
影响因子：
4.5
通讯作者：
Wang, F.
中科院分区：
文献类型：
--
作者：
Huang, H. H.;Zhang, Y. Y.;Wang, F.
这项多中心研究的目的是确定中国上海社区获得性肺炎 (CAP) 的致病病原体，并确定其对抗菌药物的敏感性。通过多种诊断工具，包括细菌培养、聚合酶链式反应 (PCR) 和特异性免疫学测定，从 2001 年至 2003 年期间记录有 CAP 的 389 名患者身上获得了病原体。采用微量肉汤稀释法检测分离菌株的敏感性。 39.8% (155/389) 的患者中鉴定出特定病原体：流感嗜血杆菌 (n=80)、克雷伯菌属。 (n=15)、肺炎链球菌 (n=12)、金黄色葡萄球菌 (n=6)、卡他莫拉氏菌 (n=1)、其他革兰氏阴性菌 (n=9) 以及非典型病原体，包括肺炎支原体 (n=42)、肺炎衣原体 (n=17) 和嗜肺军团菌 (n=2)。大多数流感嗜血杆菌分离株对氨苄青霉素敏感（88.3%），并且全部对大环内酯类敏感。在肺炎链球菌分离株中，75% (9/12) 对青霉素敏感，而 25% (3/12) 对青霉素中等敏感。流感嗜血杆菌和非典型病原体是 CAP 最重要的病原体。氨苄青霉素、头孢菌素类以及较新的氟喹诺酮类药物可作为上海地区CAP的经验性治疗。新型大环内酯类药物单一疗法治疗肺炎链球菌引起的 CAP 的疗效需要进一步评估。
The aim of this multicenter study was to identify the causative pathogens of community-acquired pneumonia (CAP) in Shanghai, China, and to determine their susceptibility to antimicrobial agents. Pathogens obtained from 389 patients with documented CAP during 2001-2003 were identified by multiple diagnostic tools that included bacterial culture, polymerase chain reaction (PCR), and specific immunological assays. Susceptibility of the bacterial isolates was tested by the broth microdilution method. A specific pathogen was identified in 39.8% (155/389) of the patients: Haemophilus influenzae (n=80), Klebsiella spp. (n=15), Streptococcus pneumoniae (n=12), Staphylococcus aureus (n=6), Moraxella catarrhalis (n=1), other gram-negative organisms (n=9), and atypical pathogens that comprised Mycoplasma pneumoniae (n=42), Chlamydia pneumoniae (n=17), and Legionella pneumophila (n=2). Most H. influenzae isolates were susceptible to ampicillin (88.3%), and all were susceptible to macrolides. Of the S. pneumoniae isolates, 75% (9/12) were susceptible to penicillin, while 25% (3/12) were intermediately susceptible. H. influenzae and atypical pathogens are among the most important pathogens of CAP. Ampicillin, cephalosporins, and the newer fluoroquinolones can be used as empirical therapy for CAP in the Shanghai area. The efficacy of monotherapy with newer macrolides for CAP caused by S. pneumoniae requires further evaluation.