医疗机构相关性肺炎和社区获得性肺炎的病原学、治疗及转归比较

目的 比较医疗机构相关性肺炎与社区获得性肺炎二者病原学特点、治疗及转归的差异.方法 收集2007年1月至2009年12月我院呼吸科住院的264例肺炎患者病例,分析比较医疗机构相关性肺炎与社区获得性肺炎的病原学特点、治疗及转归.结果 264例肺炎患者中,医疗机构相关性肺炎101例(38.26％)、社区获得性肺炎163例(...     

医疗机构相关性肺炎病原学特征分析

目的 分析医疗机构相关性肺炎（HCAP）的病原菌特征,以提高其治疗效果.方法 回顾性收集我院284例住院肺炎患者资料,比较HCAP和社区获得性肺炎（CAP）病原菌感染情况.结果 284例肺炎患者（CAP组183例,HCAP组101例）共培养出病原菌487株;CAP组前五位病原菌为肺炎链球菌43株（32.6％）,肺炎支原体24株（18.2％）,流感嗜血杆菌19株（14.4％）,铜绿假单胞菌8株（6.1％）,金黄色葡萄球菌4株（3.0％）;HCAP组前五位病原菌为铜绿假单胞菌121株（34.1％）,金黄色葡萄球菌57株（16.1％）,鲍曼不动杆菌50株（14.1％）,肺炎克雷伯菌31株（8.7％）,大肠埃希菌25株（7.0％）;HCAP组培养出革兰阴性杆菌288（81.1％）株,革兰阳性球菌67（18.9％）株,革兰阴性杆菌和革兰阳性球菌中又分别以铜绿假单胞菌[121株（42.0％）]和金黄色葡萄球菌[57株（85.1％）]最为常见.结论 HCAP病原菌种类不同于CAP,提高对HCAP病原菌种类的认识可为合理初始经验性抗生素治疗提供可靠的依据.     

Effect of Antibiotic Guidelines on Outcomes of Hospitalized Patients with Nursing Home–Acquired Pneumonia

OBJECTIVES: To compare the 2003 community-acquired pneumonia (CAP) guideline and the 2005 healthcare-associated pneumonia (HCAP) guideline on time to clinical stability, length of hospital stay, and mortality in nursing home patients hospitalized for pneumonia.
DESIGN: Retrospective study.
SETTING: Three tertiary-care hospitals.
PARTICIPANTS: Three hundred thirty-four nursing home patients.
MEASUREMENTS: Patients were classified according to the antibiotic regimens they received based on the 2003 CAP guideline or the 2005 HCAP guideline. Time to clinical stability, time to switch therapy, and mortality were evaluated in an intention-to-treat analysis. A multivariate survival model using propensity analysis was used to adjust for heterogeneity between the two groups.
RESULTS: Of the 334 patients, 258 (77%) were treated according to the 2003 HCAP guideline. Time to clinical stability did not differ between those treated according to the 2003 CAP or the 2005 HCAP guidelines. Only the Pneumonia Severity Index ( P =.006) and multilobar involvement ( P =.005) were significantly associated with delay in achieving clinical stability. Adjusted in-hospital and 30-day mortality were comparable in both cohorts (odds ratio (OR)=0.87, 95% confidence interval (CI)=0.49–1.34, and OR=0.79, 95% CI=0.42–1.31, respectively), although time to switch therapy and length of stay were longer for those treated according to the 2005 HCAP guideline.
CONCLUSION: In hospitalized nursing home patients with pneumonia, treatment with an antibiotic regimen according to the 2003 CAP guideline achieved comparable time to clinical stability and in-hospital and 30-day mortality with a regimen based on the 2005 HCAP guideline.     

Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia

CONTEXT: Traditionally, pneumonia developing in patients outside the hospital is categorized as community acquired, even if these patients have been receiving health care in an outpatient facility. Accumulating evidence suggests that health-care-associated infections are distinct from those that are truly community acquired. OBJECTIVE: To characterize the microbiology and outcomes among patients with culture-positive community-acquired pneumonia (CAP), health-care-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP).Design and setting: A retrospective cohort study based on a large US inpatient database. PATIENTS: A total of 4,543 patients with culture-positive pneumonia admitted into 59 US hospitals between January 1, 2002, and December 31, 2003, and recorded in a large, multi-institutional database of US acute-care hospitals (Cardinal Health-Atlas Research Database; Cardinal Health Clinical Knowledge Services; Marlborough, MA).Main measures: Culture data (respiratory and blood), in-hospital mortality, length of hospital stay (LOS), and billed hospital charges. RESULTS: Approximately one half of hospitalized patients with pneumonia had CAP, and > 20% had HCAP. Staphylococcus aureus was a major pathogen in all pneumonia types, with its occurrence markedly higher in the non-CAP groups than in the CAP group. Mortality rates associated with HCAP (19.8%) and HAP (18.8%) were comparable (p > 0.05), and both were significantly higher than that for CAP (10%, all p < 0.0001) and lower than that for VAP (29.3%, all p < 0.0001). Mean LOS varied significantly with pneumonia category (in order of ascending values: CAP, HCAP, HAP, and VAP; all p < 0.0001). Similarly, mean hospital charge varied significantly with pneumonia category (in order of ascending value: CAP, HCAP, HAP, and VAP; all p < 0.0001). CONCLUSIONS: The present analysis justified HCAP as a new category of pneumonia. S aureus was a major pathogen of all pneumonias with higher rates in non-CAP pneumonias. Compared with CAP, non-CAP was associated with more severe disease, higher mortality rate, greater LOS, and increased cost.     

不同类型老年吸入性肺炎的病原学、抗生素应用及临床转归

目的 比较老年社区获得性吸入性肺炎(CAP)、医疗相关性吸入性肺炎(HCAP)及医院获得性吸入性肺炎(HAP,包括呼吸机相关性吸入性肺炎)三者病原学、抗生素应用及治疗转归的关系.方法 收集2005年1月一2010年12月北京二炮总医院呼吸科住院的216例老年吸人性肺炎患者病例,分析其病原学结果、抗生素应用的及治疗转归.结果 三种吸入性肺炎的病原学有显著差异,与CAP和HCAP相比,HAP患者G-杆菌的感染比例明显增多(P<0.001);抗生素应用方案有明显差异,CAP组病人未调整抗生素应用比率明显高于HCAP组与HAP组(P<0.001);抗生素应用策略不同,所致死亡率有明显差异,以升阶梯方案为最高,以降阶梯治疗为最低(P=0.03).结论 三种吸入性肺炎在感染病原菌种类、抗生素应用策略及治疗转归上有明显差异,应根据不同类型的老年吸入性肺炎特点合理经验性使用抗菌药物.     

Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes

BACKGROUND: Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection. However, limited data exist to validate this entity. We aimed to ascertain the epidemiology, causative organisms, antibiotic susceptibilities, and outcomes of and empirical antibiotic therapy for HCAP requiring hospitalization. METHODS: Observational analysis of a prospective cohort of nonseverely immunosuppressed hospitalized adults with pneumonia. Patients who had recent contact with the health care system through nursing homes, home health care programs, hemodialysis clinics, or prior hospitalization were considered to have HCAP. RESULTS: Of 727 cases of pneumonia, 126 (17.3%) were HCAP and 601 (82.7%) were community acquired. Compared with patients with community-acquired pneumonia, patients with HCAP were older (mean age, 69.5 vs 63.7 years; P < .001), had greater comorbidity (95.2% vs 74.7%; P < .001), and were more commonly classified into high-risk pneumonia severity index classes (67.5% vs 48.8%; P < .001). The most common causative organism was Streptococcus pneumoniae in both groups (27.8% vs 33.9%). Drug-resistant pneumococci were more frequently encountered in cases of HCAP. Legionella pneumophila was less common in patients with HCAP (2.4% vs 8.8%; P = .01). Aspiration pneumonia (20.6% vs 3.0%; P < .001), Haemophilus influenzae (11.9% vs 6.0%; P = .02), Staphylococcus aureus (2.4% vs 0%; P = .005), and gram-negative bacilli (4.0% vs 1.0%; P = .03) were more frequent in HCAP. Patients with HCAP more frequently received an initial inappropriate empirical antibiotic therapy (5.6% vs 2.0%; P = .03). The overall case-fatality rate (< 30 days) was higher in patients with HCAP (10.3% vs 4.3%; P = .007). CONCLUSIONS: At present, a substantial number of patients initially seen with pneumonia in the emergency department have HCAP. These patients require a targeted approach when selecting empirical antibiotic therapy.     

Performance of PSI, CURB-65, and SCAP scores in predicting the outcome of patients with community-acquired and healthcare-associated pneumonia

The objective was to compare three score systems, pneumonia severity index (PSI), the Confusion-Urea-Respiratory Rate-Blood pressure-65 (CURB-65), and severe community-acquired pneumonia (SCAP), for prediction of the outcomes in a cohort of patients with community-acquired (CAP) and healthcare-associated pneumonia (HCAP). Large multi-center, prospective, observational study was conducted in 55 hospitals. HCAP patients were included in the high classes of CURB-65, PSI and SCAP scores have a mortality rate higher than that of CAP patients. HCAP patients included in the low class of the three severity rules have a significantly higher incidence of adverse events, including development of septic shock, transfer into an ICU, and death (p < 0.01). At multivariate Cox regression analysis, inclusion in the severe classes of PSI, CURB-65, or SCAP scores and receipt of an empirical therapy not adherent to international guidelines prove to be risk factors independently associated with poor outcome. PSI, CURB-65, and SCAP score have a good performance in patients with CAP but are less useful in patients with HCAP, especially in patients classified in the low-risk classes.     

Staphylococcus aureus bacteremic pneumonia: differences between community and nosocomial acquisition.

OBJECTIVE: The aim of the study was to ascertain the clinical and epidemiologic characteristics of patients with nosocomial or community-acquired Staphylococcus aureus bacteremic pneumonia. METHODS: A prospective study of 134 cases diagnosed between January 1990 and December 1995 was performed. RESULTS: Fifty cases involved primary bacteremic pneumonias, of which 80% were nosocomial (the majority, 72%, in intensive care unit patients, of whom 57% were post-surgery). Of the 84 cases of secondary pneumonia, 36 were non-intravenous drug users (78% nosocomial, of whom 43% were in the intensive care unit), and 48 cases were intravenous drug users (98% community-acquired). CONCLUSIONS: Nosocomial S. aureus bacteremic pneumonia was especially frequent in intensive care unit patients (68.1%), and community-acquired pneumonia in intravenous drug users (72.3%). In non-intravenous drug users, clinical outcome and mortality were similar for nosocomial and community-acquired pneumonia.     

急诊高龄卫生保健相关性肺炎患者的临床特点分析

目的 :探讨急诊高龄卫生保健相关性肺炎(HCAP)患者的临床特征及预后。方法 :对2012年1月至2013年12月急诊病房收治的年龄>80岁的高龄肺部感染患者的临床资料进行回顾性分析,比较社区获得性肺炎(CAP)组与HCAP组患者的临床特征、病原学特点及预后。结果:165例高龄肺部感染患者中,HCAP组患者的平均住院天数[(19.9±12.3)d]显著长于CAP组[(14.6±7.4)d](P<0.05),且病死率显著高于后者(22.9%比7.3%,P<0.05)。2组患者症状不典型,有基础疾病者142例(86.1%)。2组患者均存在营养不良。HCAP组患者入院时的肺炎严重度指数(PSI)显著高于CAP组(125.2±27.1比116.8±25.8,P<0.05),PSI评分Ⅴ级的比例也显著高于后者(38.6%比23.2%,P     

Methicillin-susceptible staphylococcus aureus in community-acquired pneumonia: Risk factors and outcomes

ObjectivesWe aimed to describe the prevalence, risk factors and outcomes of Methicillin-susceptible S. aureus (MSSA) community-acquired pneumonia (CAP) and compare them with those associated with CAP due to Streptococcus pneumoniae, the most frequent causative microorganism, in a large cohort of patients.MethodsThis was an observational study of prospectively collected data of consecutive adults with CAP and a definitive etiology enrolled between 2004 and 2018. Patients were divided into MSSA CAP and pneumococcal CAP groups for analysis.ResultsA microbial etiology was established in 1,548 (33%) cases: S. aureus caused 6% of microbiologically-confirmed CAP cases. In the latter, 52 were due to MSSA (60% of S. aureus CAP cases, and 3% of microbiologically-confirmed CAP cases) and 34 were due to MRSA (40% of S. aureus CAP cases, and 2% of microbiologically-confirmed CAP cases). S. pneumoniae was identified in 734 (47%) microbiologically-confirmed CAP cases. The presence of fever was independently associated with a lower risk of MSSA CAP (OR 0.53; 95% CI, 0.28–0.99). Patients with MSSA CAP had higher 30-day mortality than patients with pneumococcal CAP, both before and after adjustment for potential confounders (21% vs 7%, p = 0.002). MSSA was independently associated with 30-day mortality in the overall population.ConclusionMSSA CAP was associated with worse outcomes than pneumococcal CAP in our cohort. MSSA was an independent factor of mortality.     

Usefulness of the Japanese Respiratory Society guidelines for community pneumonia: a retrospective analysis of community-acquired pneumonia between 2000 and 2002 in a general hospital

OBJECTIVE: The aim of this study was to investigate the causative organisms of community-acquired pneumonia (CAP) diagnosed between 2000 and 2002 and to evaluate the Japanese Respiratory Society (JRS) guidelines. METHODOLOGY: A total of 124 cases of CAP diagnosed during the study period were analyzed, and the results were compared with those of a previous study by the authors' research group. Determination of the causative organisms of CAP was based on Gram stain, morphology of colonies, quantitative culture of sputum, identification of bacterial isolates, and serological tests. RESULTS: During the study period, the causative organisms were identified in 42 cases (33.8%). Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were the major causative organisms. Patients were classified into three groups based on the severity of CAP according to the JRS guidelines. The survival rates of patients with moderate and severe CAP were significantly lower than those of the mild group as evaluated by the Kaplan-Meier method (moderate vs mild, 70% vs 100%; severe vs mild, 40% vs 100%; P < 0.001 for both). Seven patients died during the study, and the risk factors were old age, bedridden status with cerebral infarction, and microaspiration, which was associated with recurrent pneumonia within 17 days. CONCLUSION: This study indicates that the JRS guidelines for CAP are useful for treating patients with CAP in Japan.     

Clinical features of healthcare-associated pneumonia (HCAP) in a Japanese community hospital: comparisons among nursing home-acquired pneumonia (NHAP), HCAP other than NHAP, and community-acquired pneumonia

Background and objective: More than 100 000 Japanese die of pneumonia every year. The number of people residing in nursing homes is increasing with the ageing of the population. In 2005, the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) published important guidelines for the management of healthcare‐associated pneumonia (HCAP). In Japan, however, the optimum strategy for management of HCAP is still unclear. The purpose of this study was to clarify the clinical features of patients with HCAP. Methods: Patients (n = 202) who were consecutively admitted with a diagnosis of acute pneumonia between October 2007 and September 2009 were retrospectively evaluated. Using the ATS/IDSA guidelines, patients were divided into three groups: a community‐acquired pneumonia (CAP) group (n = 123), a nursing home‐acquired pneumonia (NHAP) group (n = 46) and a HCAP other than NHAP (O‐HCAP) group (n = 33). These groups were then compared with respect to laboratory data, microbiological findings and mortality. Results: Thirty‐day mortality in the NHAP group (10.9%) tended to be higher than that in the CAP group (3.3%) or the O‐HCAP group (0%). The pathogens most frequently identified were Streptococcus pneumoniae and Haemophilus influenzae in the CAP group, methicillin‐resistant Staphylococcus aureus and Klebsiella pneumoniae in the NHAP group, and S. pneumoniae and K. pneumoniae in the O‐HCAP group. Conclusions: The NHAP group was clinically different from the O‐HCAP group, based on bacteriological examination and mortality rates. In order to accurately diagnose, and formulate optimum treatment strategies for Japanese patients, the categories of HCAP, as specified in the ATS/IDSA guidelines, should not be applied directly either to patients with NHAP or those with O‐HCAP.     

健康护理相关性肺炎的研究进展

健康护理相关性肺炎代表一种新的肺炎种类,有别于社区获得性肺炎和医院获得性肺炎.尽管健康护理相关性肺炎患者描述为来自于社区,但其流行病学、细菌学特征和l临床表现与社区获得性肺炎有明显差异.本文综述近年来健康护理相关性肺炎的研究进展,旨在提高临床医师对健康护理相关性肺炎的认识和深入了解.     

The comparison of patients with hospitalized health-care-associated pneumonia to community-acquired pneumonia

Health-care-associated pneumonia (HCAP) is defined as pneumonia that develops in patients with a history of recent hospitalization, hemodialysis as an outpatient, residence in a nursing home, outpatient intravenous therapy and home wound care. We aimed to compare the initial demographic characteristics, causative agents and prognosis between hospitalized HCAP and community-acquired pneumonia (CAP) patients. HCAP and CAP patients hospitalized between 01 September 2008-01 September 2009 were evaluated retrospectively. Out of 187 patients (131 males, mean age 66.3 ± 14.3 years) who were hospitalized during one-year period, 98 were diagnosed as HCAP and 89 as CAP. Among HCAP patients, 64 (65.3%) had a history of hospitalization in the last 90 days, 26 (26.5%) received outpatient intravenous therapy, 17 (17.3%) had home wound care, 6 (6.1%) were on hemodialysis program in the last 30 days and 4 (4.1%) lived in a nursing home. The causative pathogen was detected in 39 (39.8%) HCAP and 8 (9.0%) CAP patients. The most frequently isolated microorganisms were Pseudomonas aeruginosa and Acinetobacter baumannii in HCAP, and Streptococcus pneumoniae and Haemophilus influenzae in CAP patients. Inappropriate empiric antibiotic treatment was documented in 8 (25.8%) of 39 HCAP patients, in whom a causative agent was isolated whereas the antibiotic treatment was appropriate in all CAP patients. The duration of hospitalization (14.4 ± 11.4 vs. 10.7 ± 7.9 days, p= 0.011) and mortality rate (34.7% vs. 9.0%, p< 0.001) were higher in HCAP compared with CAP patients. As HCAP is different than CAP in terms of patients' characteristics, causative microorganisms and prognosis, it should be considered in all patients hospitalized as CAP. Potentially drug-resistant microorganisms should be taken into consideration in the empirical antibiotic treatment of these patients.     

Health care‐associated pneumonia in haemodialysis patients: Clinical outcomes in patients treated with narrow versus broad spectrum antibiotic therapy

Background and objective: Although the 2005 American Thoracic Society/Infectious Disease Society of America antibiotic guidelines classify pneumonia occurring in patients receiving chronic haemodialysis as health care‐associated pneumonia (HCAP), and thus recommend treatment with broad‐spectrum antibiotics for these patients, little data support this classification. We compared clinical outcomes in haemodialysis patients hospitalized with pneumonia, who were treated with broad‐spectrum antibiotics versus narrow‐spectrum antibiotics. Methods: One hundred twenty‐five haemodialysis patients with pneumonia met eligibility criteria. Categorization into the community‐acquired pneumonia (CAP) group or HCAP group was based on antibiotic therapy patients received. Time to oral therapy, time to clinical stability, length of stay and mortality were compared. Results: CAP and HCAP patients did not differ in Pneumonia Severity Index and Charlson Comorbidity index scores, but HCAP patients were more likely to meet criteria for severe pneumonia. Patients treated with HCAP therapy had a significantly longer time to oral therapy than CAP patients (9.2 vs 3.2 days, P < 0.001) and a significantly longer length of stay (11.9 vs 5.1 days, P < 0.001). Time to clinical stability was marginally longer in the HCAP group (3.1 vs 2.4 days, P = 0.07). Patients treated with HCAP therapy had longer continuation of intravenous antibiotics after reaching clinical stability (5.5 vs 0.78 days, P < 0.001). Conclusions: This study is the first to our knowledge to describe clinical outcomes in patients with haemodialysis as their only HCAP risk factor. Narrow‐spectrum antibiotics may be safe in haemodialysis patients with no other HCAP risk factors. HCAP therapy delayed de‐escalation to oral antibiotics was associated with increased duration of intravenous antibiotics and length of stay.     

Healthcare-associated pneumonia among hospitalized patients in a Korean tertiary hospital

Background  

Healthcare-associated pneumonia (HCAP) has more similarities to nosocomial pneumonia than to community-acquired pneumonia (CAP). However, there have only been a few epidemiological studies of HCAP in South Korea. We aimed to determine the differences between HCAP and CAP in terms of clinical features, pathogens, and outcomes, and to clarify approaches for initial antibiotic management.     

Clinical presentation, processes and outcomes of care for patients with pneumococcal pneumonia

OBJECTIVE: To describe the presentation, resolution of symptoms, processes of care, and outcomes of pneumococcal pneumonia, and to compare features of the bacteremic and nonbacteremic forms of this illness. DESIGN: A prospective cohort study. SETTING: Five medical institutions in 3 geographic locations. PARTICIPANTS: Inpatients and outpatients with communityacquired pneumonia (CAP). MEASUREMENTS: Sociodemographic characteristics, respiratory and nonrespiratory symptoms, and physical examination findings were obtained from interviews or chart review. Severity of illness was assessed using a validated prediction rule for short-term mortality in CAP. Pneumococcal pneumonia was categorized as bacteremic; nonbacteremic, pure etiology; or nonbacteremic, mixed etiology. MAIN RESULTS: One hundred fifty-eight (6.9%) of 2,287 patients (944 outpatients, 1,343 inpatients) with CAP had pneumococcal pneumonia. Sixty-five (41%) of the 158 with pneumococcal pneumonia were bacteremic; 74 (47%) were nonbacteremic with S. pneumoniae as sole pathogen; and 19 (12%) were nonbacteremic with S. pneumoniae as one of multiple pathogens. The pneumococcal bacteremia rate for outpatients was 2.6% and for inpatients it was 6.6%. Cough, dyspnea, and pleuritic pain were common respiratory symptoms. Hemopytsis occurred in 16% to 22% of the patients. A large number of nonrespiratory symptoms were noted. Bacteremic patients were less likely than nonbacteremic patients to have sputum production and myalgias (60% vs 82% and 33% vs 57%, respectively; P<.01 for both), more likely to have elevated blood urea nitrogen and serum creatinine levels, and more likely to receive pencillin therapy. Half of bacteremic patients were in the low risk category for short-term mortality (groups I to III), similar to the nonbacteremic patients. None of the 32 bacteremic patients in risk groups I to III died, while 7 of 23 (30%) in risk group V died. Intensive care unit admissions and pneumonia-related mortality were similar between bacteremic and nonbacteremic groups, although 46% of the bacteremic group had respiratory failure compared with 32% and 37% for the other groups. The nonbacteremic pure etiology patients returned to household activities faster than bacteremic patients. Symptoms frequently persisted at 30 days: cough (50%); dyspnea (53%); sputum production (48%); pleuritic pain (13%); and fatigue (63%). CONCLUSIONS: There were few differences in the presentation of bacteremic and nonbacteremic pneumococcal pneumonia. About half of bacteremic pneumococcal pneumonia patients were at low risk for mortality. Symptom resolution frequently was slow. This work was conducted as part of the Pneumonia PORT project, funded by a grant from the Agency for Health Care Policy and Research (R01 HS-06468) Dr. Fine is supported as a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar.     

儿童社区获得性肺炎细菌病原学特点分析研究

目的：探讨儿童社区获得性肺炎（ CAP ）细菌病原学特点及药敏情况,指导临床肺炎诊治。方法系统分析956例住院CAP患儿的临床特征,细菌病原学特点和微生物敏感性试验情况。结果956例CAP患儿痰培养中革兰阴性（ G－）杆菌为653例,占68．3％;革兰阳性（ G＋）球菌为303例,占31．7％。主要有大肠埃希杆菌253例（26．5％）,肺炎克雷伯杆菌166例（17．4％）,流感嗜血杆菌78例（8．2％）,鲍曼不动杆菌53例（5．5％）,铜绿假单胞杆菌41例（4．3％）,肺炎链球菌47例（4．9％）和金黄色葡萄球菌41例（4．3％）。二级医院CAP常见病原为流感嗜血杆菌、卡他莫拉菌、肺炎链球菌;而三级医院则为大肠埃希杆菌、肺炎克雷伯杆菌、鲍曼不动杆菌、凝固酶阴性葡萄球菌。铜绿假单胞杆菌对泰能和美罗培南均有耐药,鲍曼不动杆菌对泰能有一定的耐药率。肺炎链球菌对青霉素、复方磺胺甲恶唑、克林霉素、红霉素及阿奇霉素均耐药。金黄色葡萄球菌对青霉素全耐药,对复方磺胺甲恶唑、氨苄西林、红霉素、阿奇霉素及四环素也有较高的耐药率。结论儿童CAP病原菌中革兰阴性杆菌并不少见,对抗菌药物耐药率高,需引起重视。     

社区获得性呼吸道感染主要致病菌及其耐药性变化

肺炎链球菌(SP)和肺炎支原体(MP)是我国社区获得性肺炎(CAP)的最常见病原体,另外,细菌合并非典型病原体的混合感染亦不可忽视。SP对大环内酯类抗菌药物的耐药率迅速增加,并且其对青霉素的耐药性仍呈上升趋势。MP对大环内酯类抗菌药物的耐药率也在增加。而喹诺酮类药物对SP及非典型病原体仍具有较强抗菌活性。金黄色葡萄球菌是CAP的少见病原体,但是随着社区获得性耐甲氧西林金黄色葡萄球菌在世界范围内的增加,已引起了临床的重视。