Analysis Of Pathogen Distributoin, Drug Resistance, And The Change Of IL-2,TNF-α In Patients Of Lower Respiratory Tract Infection

Objective To investigate the distribution of pathogens in lower respiratory tract infection (LRTI) and antibiotic resistance,and correlation between interleukin-2(IL-2), tumor necrosis factor(TNF-α ) and LRTI. Methods The sputa of 296 cases with LRTI in Taiyuan city were detected by sputum culture and test of antibiotic sensitivity. Serum IL-2 and TNF- a were determined in forty nine cases which pathogen in sputum was positive and in the control group with twenty health persons. Results One hundred sixteen cases were positive in 296 patients.The positive rate was 39%.There were 20 sorts of pathogens including 132 strains,in which there were Gram negative bacillus(57.58%),Gram positive bacillus(36.36%) andfungi(6.06%). Otherwise seven cases infected with pneumonia mycoplasma.The majority was H.influenzae(18.18%),Pseudomanas(13.64%) and Acinetobacter(8.33%) in Gram negative and Streptococcus pneumoniae( 15.91 %), Streptococcus viridans( 11.3 6%), Staphylococcus edidermidis(9.09%) in Gram positive.The results of drug resistance test showed that sensitivity of Gram positive bacteria werehigh to vancomycin,cefuroxime,cefozolin and resistance to penicillin,erythromycin and ampicillin,but sensitivity of Gram negative bacteria were high to imipenem,amikacin and ceftazidime. Serum IL-2 in patients infected by both Gram positive bacteria and Gram negative bacteria is lower than that in the control group,the difference was significant(p<0.05).TNF- a in patients infected was higher than that in the control group(p<0.05). Conclusion Gram negative bacilli with high multidrug resistance were major pathogens causing LRTI in the district.Most of pathogens isolated from sputum were H.influenzae, Streptococcus pneumoniae,Pseudomonas,Streptococcus viridans, Staphylococcus edidermidis and Acinetobacter.In clinicaltherapy,sensitve antibiotics should be selected according to the results of drug resistance test.The change of bacteria resistance was obvious.The patients of LRTI with Gram positive bacteria infection should be treated with first and second generation cephalosporins firstly and the serious should be treated with vancornycin.The patients of LRTI with Gram negative bacteria infection should be treated with third generation cephalosporins and Quinolones,and the serious should be treated with imipenem.IL-2 can strength the sterilization ability of immunocyte to pathogens.The lower of IL-2 may be related with that IL-2 receptor raised and IL-2 inhibitor increased.TNF- a can active neutrophilic granulocyte and endothelial cells and stimulate the body to release inflammatory media.The high level of TNF- α may cause the body strong inflammation and even result in hypotension and multiple organ failure.So IL-2 should be raised and TNF- α should be lowered in the treatment of LRTI.Recently some researchers argued that the recombinant cellula factor or cellula resistance factor should properly be given besides antibiotics to balance the chaotic immune response during the treatment of patients with LRTI.