Etiologic Diagnosis of Adult Patients with Community-Acquired Pneumonia

社區感染性肺炎病患之病因探討

丁良文(Liang-Wen Ding) ； 余忠仁(Chong-Jen Yu)

《胸腔醫學》 18卷1期 (2003/02) Pp. 28-36

摘要

背景：本研究的目的在於研究在2000年7月到2001年6月，因為社區感染性肺炎於台大醫院內科就診之成人病患，其病因之探討。
方法：這是一個前瞻性研究，在35個病患當中，有19名男性（54%），所有受試者平均年齡為61 ± 22歲（平均 ± 標準差）。所有病患均因疑似社區感染性肺炎於台大醫院內科就診。病因之診斷方法主要根據血液或肋膜積液培養陽性，或是尿液中之肺炎雙球菌抗原檢驗陽性，或是肺炎黴漿菌、披衣菌、退伍軍人桿菌之抗體力價有顯著變化。
結果：於31位社區感染性肺炎病患中得到確實病因（88.6%），病原之分佈為：第一位為肺炎黴漿菌，19名（54.3%）；披衣菌次之，13名（37.1%）；其次為肺炎雙球菌，7名（20%）；退伍軍人桿菌，0%。在10位病患中，有二種致病菌被發現，其中最常見為肺炎黴漿菌、披衣菌之合併感染（7位病患，20%）。無論在年輕組（18~60歲） 或年老組（大於60歲），肺炎黴漿菌感染均為首位，而肺炎雙球菌均較肺炎黴漿菌和披衣菌來的少見。
結論：在台北的社區感染性肺炎之致病菌和文獻上所報告的並不完全相同，於本土的調查發現肺炎黴漿菌及披衣菌佔了相當高的比例（71.4%），肺炎雙球菌只佔20%。而合併二種致病菌的病患有10位，佔所有的28.6%，其中又以肺炎黴漿菌及披衣菌合併感染為最多，佔了其中70%。在本研究中顯示，因為非典型肺炎的高盛行率、以及由臨床表現及影像學並無法分別典型及非典型肺炎，我們建議在台北地區，所有社區感染性肺炎在治療上均應給予macrolide抗生素。

關鍵字

社區感染性肺炎 ； 非典型肺炎 ； 病因

並列摘要

Background: The purpose of this study was to assess the causes of community-acquired pneumonia in adults visiting National Taiwan University Hospital (NTUH) over a period of one year.
Methods: From July 1, 2000 to June 30, 2001, a prospective study was carried out at NTUH, and entailed the enrollment of adult patients with a diagnosis of community-acquired pneumonia (CAP). The etiological diagnosis for CAP was based on positive blood or pleural fluid cultures and/or a positive pneumococcal urinary antigen test, with significant changes in antibody titers to Mycoplasma pneumoniae, Chlamydiae pneumoniae, and Legionella species.
Results: A total of 35 adult patients (19 men and 16 women) with CAP were included, and their ages were within the range of 61 ± 22 (mean ± SD) years. The etiology of the community-acquired pneumonia was identified in 31 patients (88.6%). The causative pathogens were as follows: Mycoplasma pneumoniae, 19 patients (54.3%); Chlamydiae pneumoniae, 13 patients (37.1%); Streptococcus pneumoniae, 7 patients (20%); Staphylococcus aureus, 1 patient (2.9%), Peptostreptococcus micros, 1 patient (2.9%); Legionella species, 0%. In 10 patients (28.6%), 2 causal pathogens were found, and the most frequent concomitant etiologies were M. pneumoniae and C. pneumoniae (7 patients). In patients above the age of 60 years, M. pneumoniae was the most frequent etiological pathogen (13, 61.9%), and C. pneumoniae was the second most frequent pathogen (7, 33.3%). In patients below the age of 60, M. pneumoniae and C. pneumoniae were both the most frequent pathogens (6, 42.9%), and the second most frequent pathogen was S. pneumoniae (5, 35.7%).
Conclusion: Pneumonia caused by atypical pathogens is not uncommon, and concomitant infection with 2 pathogens is not rare. The importance of atypical pathogens cannot be overemphasized. We suggest that the treatment of all patients with community-acquired pneumonia should include a marcolide antibiotic despite the high resistance of S. pneumoniae to macrolide in this area.

並列關鍵字

community-acquired pneumonia ； etiology ； atypical pneumonia