Burack J H, Hahn J A, Saint-Maurice D, Jacobson M A
Department of Medicine, University of California, San Francisco.
Arch Intern Med. 1994 Nov 28;154(22):2589-96.
Bacterial pneumonia is a very common cause of morbidity and mortality among persons with human immunodeficiency virus; however, the microbiologic characteristics (including antibiotic resistance) of bacterial pathogens causing community-acquired pneumonia in this population have not been well characterized or correlated with potentially predictive clinical presentation characteristics.
We conducted a retrospective cohort study of all adults known to have or to be at high risk for human immunodeficiency virus infection and hospitalized at San Francisco (Calif) General Hospital from May 1990 through April 1991, with a hospital discharge diagnosis of community-acquired bacterial pneumonia and for whom a medical records review confirmed that this diagnosis met a uniform case definition.
Two hundred sixteen eligible patients had one or more hospital admissions meeting the case definition. One or more etiologic pathogens were definitively identified in 75% of cases, with Streptococcus pneumoniae, Haemophilus species, Staphylococcus aureus, and gram-negative bacilli most frequently identified. In patients who had a bacteriologic diagnosis made, 18.6%, 6.8%, and 4.3% had pneumonia caused by pathogens resistant to ampicillin sodium, cefuroxime sodium, or trimethoprim-sulfamethoxazole, respectively. One hundred percent of pathogens isolated were susceptible to ceftazidime. Anemia and use of antibacterial medication at the time of hospital admission were the only independent predictors of ampicillin and cefuroxime resistance.
Nearly one fifth of human immunodeficiency virus-associated community-acquired bacterial pneumonias requiring hospitalization were caused by ampicillin-resistant pathogens, and presenting clinical characteristics did not consistently define a subset of patients at lower risk for resistance. In the absence of a diagnostic sputum Gram's stain and pending definitive microbiologic diagnosis, initial empiric therapy should be with a second- or third-generation cephalosporin or possibly trimethoprim-sulfamethoxazole.
细菌性肺炎是人类免疫缺陷病毒感染者发病和死亡的常见原因；然而，该人群中引起社区获得性肺炎的细菌病原体的微生物学特征（包括抗生素耐药性）尚未得到充分描述，也未与潜在的预测性临床表现特征相关联。
我们对1990年5月至1991年4月在旧金山总医院住院的所有已知感染人类免疫缺陷病毒或有高感染风险的成年人进行了一项回顾性队列研究，这些患者出院诊断为社区获得性细菌性肺炎，病历审查证实该诊断符合统一的病例定义。
216名符合条件的患者有一次或多次住院符合病例定义。75%的病例中明确鉴定出一种或多种病原体，最常见的是肺炎链球菌、嗜血杆菌属、金黄色葡萄球菌和革兰氏阴性杆菌。在进行细菌学诊断的患者中，分别有18.6%、6.8%和4.3%的肺炎由对氨苄西林钠、头孢呋辛钠或甲氧苄啶 - 磺胺甲恶唑耐药的病原体引起。分离出的病原体100%对头孢他啶敏感。贫血和入院时使用抗菌药物是氨苄西林和头孢呋辛耐药的唯一独立预测因素。
近五分之一需要住院治疗的与人类免疫缺陷病毒相关的社区获得性细菌性肺炎由耐氨苄西林病原体引起，目前的临床表现并不能始终确定耐药风险较低的患者亚组。在缺乏诊断性痰革兰氏染色且微生物学诊断未明确之前，初始经验性治疗应使用第二代或第三代头孢菌素，或可能使用甲氧苄啶 - 磺胺甲恶唑。
