地區醫院急性肺部細菌感染的種類－從抗生素的角度觀之

Acute Pulmonary Bacterial Infection in a Community Hospital - Viewed from the Sensitivity Pattern

楊治國(Gee-Gwo Yang)

《慈濟醫學雜誌》 2卷3期 (1990/05) Pp. 200-206

https://doi.org/10.6440/TZUCMJ.199005.0200

摘要

為了瞭解花蓮地區肺部細菌感染者，其細菌種類與抗藥性是否因抗生素的濫用而改變，因此統計自民國77年至79年，花蓮社區居民至慈濟醫院，診斷為肺部感染，其致病細菌經血液、胸水、或肺部針刺抽吸培養而證實，或經血清學檢驗而證實者，共男性21位，女性4位。肺炎仍以肺炎鏈球菌最多（5／8）其次是肺炎黴漿菌（2／8）。肺膿瘍則以草綠色鏈球菌最多（4／6），肋膜腔蓄膿以肺炎克萊勃士桿菌、大腸桿菌為主（4／6），菌血性肺栓塞以金黃色葡萄球菌為主（3／5）。對於抗生素，肺炎鏈球菌與草綠色鏈球菌仍然對盤尼西林有實驗室感受性（12／12），但對口服紅黴素則50%有抗藥性。肺炎克萊勃士桿菌與大腸桿菌則對氨基配糖類抗生素或第2代頭芽胞菌素有感受性（8／8），但對口服磺胺類已有抗藥性菌種出現（67%）。金黃色葡萄球菌則祇有1／3對抗盤尼西林酶的盤尼西林類抗生有感受性。因此吾人結論，花蓮社區居民，在社區得到細菌性肺炎，仍與抗生素未廣泛濫用時期菌種相似，大多數細菌仍對常用注射型抗生素有感受性，唯對口服抗生素已有抗藥性菌種出現，吾人仍應加強管制抗生素，以免因濫用而污染此地區。

關鍵字

細菌 ； 肺炎 ； 肺膿瘍 ； 肋膜腔蓄膿 ； 抗生素

並列摘要

In order to evaluate the causative micro-organisms for community-acquired pneumonia and change from the pressure of antibiotics abuse, we retrospectively analyzed 21 men and 4 women admitted to Tz’u-Chi General hospital from 1988 to 1990. They were diagnosed as bacterial pneumonia, lung abscess, empyema or septic lung emboli. With the exception of Mycoplasma pneumonia, which we diagnosed on the basis of 4-fold rise of Mycoplasma antibody titer, we culture the causative bacteriae from blood, pleural effusion or percutaneous lung aspirate. The most common causative bacteriae are pneumococcus (5/8) and Mycoplasma pneumoniae (2/8) in pneumonia, viridans streptococci (4/6) in lung abscess, Klebsiella pneumoniae and E. coli in empyema (4/6) and Staphylococcus aureus (3/5) in septic lung emboli. The pneumococcus and viridans streptococci are still susceptible to penicillin inhibition (12/12), but resistant to erythromycin in 50% cases. K. pneumoniae and E. coli are suscep-tible to aminoglycoside and third-generation cephalosporin (8/8), but resistant to oral cotrimoxazole in 67%. Staphylococcus aureus is susceptible to penicillinase-resistant penicillin in only 1/3 cases. We conclude that the causative bacteriae for community-acquired pneumonia do not differ from those before antibiotics were widely abuse. The emergence of resistant strains to oral antibiotics suggest poor control of oral antibiotic usage.

並列關鍵字

Bacteria ； Pneumcnia ； Lung abscess ； empyema ； antibiotics