老人最常見的肺炎病原是 肺炎雙球菌

雖然肺炎雙球菌是最常見的細菌病原，但是有較少數病原是更容易致命的革蘭陰性或其他革蘭陽性菌。選用第一線抗生素，切忌只針對肺炎雙球菌選藥。對老年、有多種慢性病、抵抗力弱、感染嚴重病患，一定要有 "降階式抗生素治療"的觀念。

 

Antimicrobial Susceptibilities and Serotypes of Streptococcus pneumoniae Isolates from Elderly Patients with Pneumonia and Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Antimicrob Agents Chemother.  2011; 55(6):2729-34 (ISSN: 1098-6596)

Pérez-Trallero E; Marimón JM; Larruskain J; Alonso M; Ercibengoa M
Servicio de Microbiología-Instituto Biodonostia, Hospital Donostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain. mikrobiol@terra.es.

In the elderly, Streptococcus pneumoniae is the most common cause of pneumonia and one of the most frequently isolated pathogens in cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study was conducted to compare the pneumococcal isolates obtained during episodes of AECOPD and pneumonia in patients of ≥65 years old and to analyze whether in patients with AECOPD and pneumonia within a short interval, the same isolate caused both episodes. This laboratory-based study was performed between 2005 and 2008. Pneumococcal isolates from episodes of pneumonia (n = 401) and AECOPD (n = 398), matched one-to-one by date of isolation, were characterized. The serotypes and genotypes of other pneumococcal isolates causing pneumonia and AECOPD in the same patient were compared. In patients with pneumonia, COPD as an underlying disease was not associated with more-drug-resistant pneumococci. In contrast, isolates causing AECOPD showed higher rates of resistance than those causing pneumonia. Serotypes 1, 3, and 7F were more frequent in pneumonia. The same pneumococcus was involved in 25.7% (9/35 patients) of patients with two consecutive AECOPD episodes but in only 6.3% (2/32 patients) of COPD patients with pneumonia and exacerbation (Fisher's exact test; P = 0.047). Less invasive serotypes were isolated more often in AECOPD and were more resistant to antimicrobials. The presence of a specific pneumococcal serotype in AECOPD does not predict the etiology of subsequent pneumonia.

·         PreMedline Identifier: 21402843

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.