非典型病原体与细菌感染所致社区获得性肺炎的治疗

Therapeutic analysis of community acquired pneumonia caused by atypical pathogens and bacteria

  • 摘要: 目的: 对非典型病原体与细菌感染所致社区获得性肺炎(CAP)的治疗进行分析,以指导经验性治疗CAP的抗生素选择。方法: 入选2003年12月2004年11月中国7个城市12家医院病原学诊断明确的315例CAP患者,分四组进行疗效分析。结果: 315例CAP患者中,β-内酰胺类抗生素单用的有效率为90.3%(112/124),β-内酰胺类合用大环内酯类抗生素或应用含氟喹诺酮类抗生素治疗方案的有效率为95.7%(180/188)。非典型病原体单一或混合感染者,应用含大环内酯类或氟喹诺酮类抗生素治疗的患者在有效率上并不优于单用β-内酰胺类抗生素者。对有合并症、肺炎支原体或肺炎衣原体混合细菌感染患者β-内酰胺类合用大环内酯类抗生素或含氟喹诺酮类抗生素治疗的有效率优于β-内酰胺类抗生素单用者。结论: 在我国非典型病原体在CAP中所占比例较大,建议在治疗时选择对非典型病原体有效的抗生素,尤其是对有基础疾病或修正因子的患者,经验治疗的选择应覆盖非典型病原体。

     

    Abstract: Objective: To analyze the therapeutic efficacy of community acquired pneumonia(CAP) caused by atypical pathogens and bacteria,in order to guide the experimental therapeutic choice of antibiotics for CAP.Methods: Therapeutic efficacy was analyzed on 315 adult patients with CAP,of which the causative pathogens were identified at 12 centers in 7 Chinese cities from December 2003 to November 2004.Results: In 315 patients with CAP,the effective rate of therapy with β-lactam antibiotics was 90.3%;and that with β-lactam antibiotics plus macrolides or antibiotics containing floroquinilones was 95.7%.Treatment improvement in patients with atypical pathogen causes(mono-infection or mixed infection) showed no advantage of macrolides or floroquinolones over β-lactam antibiotics.In patients had comorbid illness with infection of mycoplasma pneumoniae and /or Chlamydia pneumoniae mixed bacteria,clinical outcome with therapy of β-lactam plus macrolides or floroquinolones was better than β-lactam antibiotics.Conclusion: Because high percentage of atypical pathogen in CAP in China,it is suggested to choose antibiotics active against atypical pathogen,especially for patients with comorbid illness or having modifying factors;therapies should involve in anti-atypical pathogens.

     

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