Yatera Kazuhiro, Noguchi Shingo, Yamasaki Kei, Kawanami Toshinori, Fukuda Kazumasa, Naito Keisuke, Akata Kentaro, Kido Takashi, Ishimoto Hiroshi, Sakamoto Noriho, Taniguchi Hatsumi, Mukae Hiroshi
Department of Respiratory Medicine, University of Occupational and Environmental Health.
Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health.
Tohoku J Exp Med. 2017 May;242(1):9-17. doi: 10.1620/tjem.242.9.
Obtaining precise etiological information regarding causative bacteria is important for the proper use of antimicrobials in hospital-acquired pneumonia (HAP), which is associated with a high rate of mortality. The aim of this study was to comparatively investigate the bacterial diversity in bronchoalveolar lavage fluid (BALF) in Japanese patients with HAP by the clone library method using the 16S rRNA gene. This study included Japanese patients with HAP who were treated at our hospital and referring hospitals. BALF specimens were obtained from pneumonia lesions identified on chest radiographs and/or computed tomography. Sputum specimens were also evaluated in patients with sputum production. Sixty-eight patients were ultimately enrolled. BALF cultivation revealed bacterial positivity in 53 of 68 (77.9%) patients, and Staphylococcus aureus (30.9%) was the most frequently isolated, followed by Pseudomonas aeruginosa (16.2%), and Escherichia coli (10.3%). In contrast, the clone library analysis identified the presence of some bacterial phenotype in 65 of 68 (95.6%) patients, and streptococci (16.2%), Corynebacterium species (11.8%), anaerobes (10.3%) were frequently detected as the predominant phylotypes. Both methods tended to detect S. aureus, Klebsiella pneumoniae, and E. coli in patients with late-onset pneumonia. In addition, the cases that phylotypes of S. aureus and P. aeruginosa were found to account for > 5% of the bacterial flora of each case were 42.9% and 72.7%, respectively. These results indicate that attention should be paid to the roles of gram-positive bacilli such as streptococci, Corynebacterium species and anaerobes, in addition to Gram-negative bacilli, in the pathogenesis of HAP.
获取有关致病细菌的确切病因信息对于医院获得性肺炎（HAP）中抗菌药物的合理使用非常重要，HAP与高死亡率相关。本研究的目的是通过使用16S rRNA基因的克隆文库方法，比较调查日本HAP患者支气管肺泡灌洗液（BALF）中的细菌多样性。本研究纳入了在我院及转诊医院接受治疗的日本HAP患者。BALF标本取自胸部X线片和/或计算机断层扫描确定的肺炎病灶。有痰的患者也对痰标本进行了评估。最终纳入68例患者。BALF培养显示68例患者中有53例（77.9%）细菌呈阳性，最常分离出的是金黄色葡萄球菌（30.9%），其次是铜绿假单胞菌（16.2%）和大肠杆菌（10.3%）。相比之下，克隆文库分析在68例患者中的65例（95.6%）中发现了一些细菌表型，链球菌（16.2%）、棒状杆菌属（11.8%）、厌氧菌（10.3%）常被检测为主要系统发育型。两种方法在晚发性肺炎患者中都倾向于检测到金黄色葡萄球菌、肺炎克雷伯菌和大肠杆菌。此外，金黄色葡萄球菌和铜绿假单胞菌的系统发育型在各病例细菌菌群中占比>5%的病例分别为42.9%和72.7%。这些结果表明，除革兰氏阴性杆菌外，还应关注革兰氏阳性杆菌如链球菌、棒状杆菌属和厌氧菌在HAP发病机制中的作用。
