摘 要：目的：探讨本地区重症社区获得性肺炎(SCAP)的病原学与药敏特点，为合理使用抗生素提供依据。方法：采用VITEK- AMS微生物分析仪测定病原菌，并用纸片法(Kirby- Bauer)测定病原菌的体外药物敏感性。结果：69例患者，年龄20～95岁，平均65±18岁，≥65岁49例，占71.0%。91.3%(63/69)患者有基础疾病，其中慢性阻塞性肺病最常见。临床表现为咳嗽(100%)，咳黄脓痰(86.9%)，肺部出现湿罗音(100%)，高热(43.5%)，意识障碍(43.5%)。所有患者进行了病原学检查，50例患者培养出54株细菌，17例合并真菌感染；54株细菌中革兰阳性需氧菌13株，以葡萄球菌属为主，占12株；革兰阴性杆菌41株，以铜绿假单胞菌为主，占11株，嗜麦芽窄食单胞菌9株，肠杆菌科8株。铜绿假单胞菌依次对头孢派酮钠/舒巴坦钠(78%)、特治星(75%)及泰能(70%)敏感；肠杆菌科对泰能(87.5%)、头孢派酮钠/舒巴坦钠(66.7%)与特治星(62.5%)敏感。治愈31例(44.9%)，好转10例(14.5%)，自动出院12例(17.4%)，死亡16例(23.2%)。结论：SCAP多发生于老年人；病原体中革兰阴性菌占76.0%，以铜绿假单胞菌为主，其次是嗜麦芽窄食单胞菌，革兰阳性需氧菌占24%，以葡萄球菌属为主；入院初期经验治疗应选择广谱的强有力抗菌素，再根据病原体检测结果改用针对性强、窄谱的抗菌药物。

    关键词： 重症社区获得性肺炎； 铜绿假单胞菌； 病原学； 药物敏感性

    Study the Characteristics of Etiology and Drug Sensitivity About Serious Community Acquired Pneumonia

    XIAO Ling, ZHEN Zhong- sheng, ZHEN Xiao- he, et al

    (The First Affiliated Hospital to Shantou University Medical college, Guangdong Shantou 515041, China)

    Abstract: Objective: To investigate the pathogen and antibiotic sensitivity of serious community acquired pneumonia (SCAP) in our hospital and to evaluate the clinical characteristics of SCAP, aiming at providing evidence for using antibiotic. Method: The bacteria were tested with VITEK- AMS, and the drug sensitivity against bacteria by K- B method was studied. Result: There were 52 males and 17 females, the mean age being 65±18 years. 91.3% of cases had underlying diseases, most of which were COPD. Clinical manifestations included cough (100%), purulent sputum (86.9%), bubble (100%), hyperpyrexia (43.5%) and conscious disturbance (43.5%). There were 54 strains bacteria of 50 cases through sputum culture, and 17cases were complicated with fungus. Gram- positive bacteria were 13 stains, most of which were staphylococci. Gram- negative bacteria were 41strains, including 11strains of pseudomonas aeruginosa, 9strains of xanthomonas maltophilia, 8 strains of enterobacterianceae, and so on. The drug sensitivity rate towards pseudomonas aeruginosa was sulperazone 78%, tazocin 75% and tienam 70% respectively. That towards enterobacterianceae was tienam 87.5%, sulperazone 66.7% and tazocin 62.5% respectively. 44.9% cases were healing. 14.5% were improved. 17.4% quitted treatment and 23.0% were fatality. Conclusion: SCAP easy occurred in the aged people. The pathogen of sputum included 76.0% of gram- negative bacteria and 24.0% of gram- positive bacteria. The major of gram- egative bacteria was pseudomonas aeruginosa, and the main of gram- positive bacteria was staphylococci. It was reasonable to elect powerful and broad- spectrum antibiotic in the initially experiential therapy, then use the strong and narrow-spectrum antibiotic according to the pathogen and drug sensitivity. ......