| Objective: To analyze the etiological distribution and composition ratio of 144 hospitalized patients with community-acquired pneumonia(CAP),to compare the etiological detection rates of bronchoalveolar lavage fluid(BALF),lower respiratory tract secretion and sputum from three different sourced specimens in hospitalized patients with CAP,so as to provide a basis for the diagnosis and treatment of hospitalized patients with CAP.Methods:From August 2016 to January 2019,144 patients diagnosed as CAP and hospitalized in the second department of respiratory medicine of the second hospital of hebei medical university were studied.Collecting hospitalized patients with CAP gender,age,basic diseases and other clinical data,sputum,lower respiratory tract secretion and BALF were bacterial and fungal culture,comparing the differences of etiological detection rates from three different sourced specimens,analyzing the etiological distribution and composition ratio of hospitalized patients with CAP,the result of the separation of training were retrospectively analyzed.Results:1.Basic data: 144 cases hospitalized patients with CAP,including 88 males and 56 females,whose age fluctuated from 18 to 86 years old,with an average age of 55.81 ±14.36 years old.The 144 cases hospitalized patients with CAP,96 were combined with basic diseases,including 45 cases with 1 basic disease,24 cases with 2 basic diseases,and 27 cases with 3 or more basic diseases.There were 30 cases severe CAP patients and 114 cases non-severe CAP patients.There were 20 cases immunosuppressive CAP patients and 124 cases non-immunosuppressive CAP patients.There were 14 cases mechanical ventilation CAP patients and 130 cases non-mechanical ventilation CAP patients.Before bacterial and fungal culture,144 cases hospitalized patients with CAP(100%)were treated with antibacterial agents,35(24.31%)with antiviral agents,and 10(6.94%)with hormone/immunosupp ressant.2.Distribution of complications:144 cases hospitalized patients with CAP,diabetes mellitus in 36 cases(25.00%),high blood pressure in 29 cases(20.14%),anemia in 28 cases(19.44%),cerebrovascular disease in 23 cases(15.97%),coronary heart disease in 17 cases(11.81%),chronic obstructive pulmonary disease(COPD)in 13 cases(9.03%),autoimmune disease in 8 cases(5.56%),arrhythmia in 7 cases(4.86%),chronic gastritis in 7 cases(4.86%),renal failure in 4 cases(2.78%),heart failure in 3 cases(2.08%),hepatitis in 3 patients(2.08%),liver failure in 3 cases(2.08%),nephrotic syndrome in 2 cases of(1.39%),hypothyroidism in 2 cases(1.39%),cardiac valvular disease in 1 case(0.69%).3.Distribution of immune state: 144 cases hospitalized patients with CAP,immunosuppressive CAP patients in 20 cases(13.89%),including 9 cases(6.25%)patients with malignant tumor,7 cases(4.86%)patients with hormone therapy,7 cases(4.86%)patients with immunosuppression,4 cases(2.78%)patients with renal failure,3 cases(2.08%)patients with liver failure,1 case(0.69%)patients with hemodialysis.4.Etiological distribution and composition ratio in overall:The total number of etiological detected in 144 cases hospitalized patients with CAP was 57,and a total of 81 strains of pathogenic bacteria were cultured,including gram-positive bacteria 6.17%,gram-negative bacteria 54.32% and fungi 39.51%.The first three etiological were klebsiella pneumoniae,acinetobacter bauman-nii and candida albicans.5.Etiological distribution and composition ratio in severe CAP patients: The total number of etiological detected in 30 patients with severe CAP was 23,and a total of 38 strains of pathogenic bacteria were cultured,including gram-positive bacteria 7.89%,gram-negative bacteria 63.16% and fungi 28.95%.The first three etiological were klebsiella pneumoniae,acine-tobacter baumannii and pseudomonas aeruginosa.6.Etiological distribution and composition ratio in non-severe CAP patients: The total number of etiological detected in 114 patients with non-severe CAP was 34,and a total of 43 strains of pathogenic bacteria were cultured,including gram-positive bacteria 4.65%,gram-negative bacteria 46.51% and fungi 48.84%.The first three etiological were candida albicans,klebsiella pneumoniae and acinetobacter baumannii.7.Etiological distribution and composition ratio in immunosuppressive CAP: The total number of etiological detected in 20 patients with immunosuppressive CAP was 14,and a total of 18 strains of pathogenic bacteria were cultured,including gram-positive bacteria 11.11%,gramnegative bacteria 66.67% and fungi 22.22%.The first three etiological were acinetobacter baumannii,klebsiella pneumoniae and candida smooth.8.Etiological distribution and composition ratio in non-immunosuppressive CAP: The total number of etiological detected in 124 patients with non-immunosuppressive CAP was 46,and a total of 63 strains of pathogenic bacteria were cultured,including gram-positive bacteria 4.76%,gram-negative bacteria 50.79% and fungi 44.45%.The first three etiological were candida albicans,klebsiella pneumoniae and acinetobacter baumannii.9.Etiological distribution and composition ratio in mechanical ventilation CAP: The total number of etiological detected in 14 patients with mechanical ventilation CAP was 12,and a total of 18 strains of pathogenic bacteria were cultured,including gram-positive bacteria 11.11%,gram-negative bacteria 61.11% and fungi 27.78%.The first three etiological were acinetobacter baumannii,klebsiella pneumoniae,and candida albicans.10.Etiological distribution and composition ratio in non-mechanical ventilation CAP: The total number of etiological detected in 130 patients with non-mechanical ventilation CAP was 45,and a total of 63 strains of pathogenic bacteria were cultured,including gram-positive bacteria 4.76%,gram-negative bacteria 52.38% and fungi 42.86%.The first three etiological were candida albicans,klebsiella pneumoniae and acinetobacter baumannii.11.Comparison of etiological detection rates from three different sourced specimens:144 cases hospitalized patients with CAP underwent BALF,lower respiratory tract secretion,sputum bacterial and fungal culture,the total etiological detection rates was 39.58%(57 cases)and BALF culture etiological detection rates was 25.69%(37 cases),lower respiratory tract secretion culture etiological detection rates was 23.61%(34 cases),sputum culture(3 times or less)etiological detection rates was 26.39%(38 cases),sputum culture(6 times or less)etiological detection rates was 28.47%(41 cases),There was no statistical difference in the etiological detection rates in BALF,lower respiratory tract secretion,sputum(3 times or less)and sputum(6 times or less)cultures(P>0.05).12.Comparison of etiological detection rates in severe CAP and non-severe CAP: Total of 30 cases severe CAP patients etiological detection rates was 76.67%,BALF culture etiological detection rates was 60.00%,the lower respiratory tract secretion culture etiological detection rates was 53.30%,sputum culture(3 times or less)etiological detection rates was 60.00%,sputum culture(6 times or less)etiological detection rates was 60.00%,BALF,lower respiratory tract secretion and sputum(3 times or less)or less,(6 times or less)training is no statistical difference between etiological detection rates(P>0.05).Total of 114 cases non-severe CAP patients etiological detection rates was 29.82%,BALF culture etiological detection rates was 16.67%,the lower respiratory tract secretion culture etiological detection rates was 15.79%,sputum culture(3 times or less)detection rate of etiology was 17.54%,sputum culture(6 times or less)etiological detection rates was 20.18%,BALF,lower respiratory tract secretions,sputum(3 times or less),(6 times or less)training is no statistical difference between etiological detection rates(P> 0.05).There were statistically significant differences in the detection rates of total aetiology of severe CAP and non-severe CAP,aetiology of BALF culture,aetiology of lower respiratory tract secretion culture,aetiology of sputum culture(3 times or less)and aetiology of sputum culture(6 times or less)(P<0.05).13.Comparison of etiological detection rates in immunosuppressive CAP and non-immunosuppressive CAP: Total of 20 cases immunosu-ppressive CAP patients etiological detection rates was 76.67%,BALF culture etiological detection rates was 50.00%,the lower respiratory tract secretion culture etiological detection rates was 40.00%,sputum culture(3 times or less)etiological detection rates 30.00%,sputum culture(6 times or less)etiological detection rates 35.00%,BALF,lower respiratory tract secretion and sputum(3 times or less),(6 times or less)training is no statistical difference between etiological detection rates(P>0.05).Total of 124 cases non-immunosuppressiv-e CAP patients etiological detection rates was 37.10%,BALF culture etiological detection rates was 21.77% and the lower respiratory tract secretion culture etiological detection rates was 20.97%,sputum culture(3 times or less)etiological detection rates was 25.81%,sputum culture(6 times or less)etiological detection rates was 27.42%,BALF,lower respiratory tract secretion and sputum(3 times or less),(6 times or less)training is no statistical difference between etiological detection rates(P>0.05).There were no statistically significant differences between the detection rates of total pathogens of immunosuppressive CAP and non-immunosuppressive CAP,pathogens of BALF culture,pathogens of lower respiratory tract secretions culture,pathogens of sputum culture(3 times or less)and pathogens of sputum culture(6 times)(P>0.05),and the etiological detection rates of BALF culture were statistically significant(P<0.05).14.Comparison of etiological detection rates in mechanical ventilation CAP and non-mechanical ventilation CAP:Total of 14 cases mechan-ical ventilation CAP patients etiological detection rates was 85.71%,BALF culture etiological detection rates was 64.29%,the lower respiratory tract secretion culture etiological detection rates was 57.14%,sputum culture(3 times or less)etiological detection rates was 64.29%,sputum culture(6 times or less)etiological detection rates was 71.43%,BALF,lower respiratory tract secretion and sputum(3 times or less),(6 times or less)training is no statistical difference between etiological detection rates(P>0.05).Total of 130 cases non-mechanical ventilation CAP patients etiological detection rates was 34.62%,BALF culture etiological detection rates was 21.54%,the lower respiratory tract secretion culture etiological detection rates was 20.00%,sputum culture(3 times or less)etiological detection rates was 22.31%,sputum culture(6 times or less)etiological detection rates was 23.08%,BALF,lower respiratory tract secretion and sputum(3 timesor less),(6 times or less)training is no statistical difference between etiological detection rates(P>0.05).There were statistically significant differences in the detection rates of total aetiology of mechanical ventilation CAP and non-mechanical ventilation CAP,aetiology of BALF culture,aetiology of lower respiratory tract secretion culture,aetiology of sputum culture(3 times or less)and aetiology of sputum culture(6 times or less)(P<0.05).Conclusion:1.The first three etiological in 144 hospitalized patients with CAP were klebsiella pneumoniae,acinetobacter baumannii and candida albicans.2.There was no difference in the etiological detection rates from three different sourced specimens(BALF,lower respiratory tract secretion,sputum)in hospitalized CAP patients.3.The etiological detection rates of BALF culture in immunosuppressive CAP patients was higher.4.The etiological detection rates of severe CAP patients was higher than that of non-severe CAP patients.5.The etiological detection rates of mechanical ventilation CAP patients was higher than that of non-mechanical ventilation CAP patients. |
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