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目的回顾性分析住院老年社区获得性肺炎(CAP)患者的主要病原体,以指导临床抗感染用药。方法选取258例老年CAP患者,进行病原学鉴定,每例患者均予以痰培养和血清学检测肺炎支原体和衣原体、军团菌抗体和呼吸道病毒,体温>38.5℃进行血培养。结果 72例患者的病原学检测阳性,占全部患者27.9%,其中痰培养49例阳性,占阳性患者的68.1%,血培养阳性3例,占阳性患者的4.2%,非典型病原体感染20例,占阳性患者的27.8%,其中革兰阴性菌感染率为15.3%。结论肺炎链球菌仍是引起老年CAP最常见的病原体,不典型致病菌感染日益增多,而高龄患者,由于基础疾病较多,长期反复住院,尤其许多患者有基础肺疾病,故铜绿假单胞菌等革兰阴性杆菌感染也占一定比例,还应考虑覆盖铜绿假单胞菌感染的药物治疗。
Objective To retrospectively analyze the major pathogens of hospitalized elderly patients with community-acquired pneumonia (CAP) to guide the clinical anti-infective medication. Methods A total of 258 elderly patients with CAP were enrolled in the etiological diagnosis. Mycoplasma pneumonia and Chlamydia pneumophila, Legionella pneumophila and respiratory virus were detected in each patient by sputum culture and serological tests. Blood cultures were performed at body temperature> 38.5 ℃. Results 72 patients were positive for etiology, accounting for 27.9% of all patients, of which 49 were sputum culture positive, accounting for 68.1% of positive patients, 3 were positive blood culture, accounting for 4.2% of positive patients, 20 were atypical pathogens, Accounting for 27.8% of positive patients, of which gram-negative bacteria infection rate was 15.3%. Conclusion Streptococcus pneumoniae is still the most common causative agent of elderly CAP, and the number of atypical pathogenic bacteria is increasing. In elderly patients, due to more underlying diseases, long-term repeated hospitalization, especially in many patients with underlying lung disease, Gram-negative bacilli and other bacteria also account for a certain percentage of infection should also be considered to cover the drug treatment of Pseudomonas aeruginosa infection.