| Community-acquired pneumonia (CAP) remains a major threat to human health. Data from the United States revealed that 2 ~ 3 million cases of CAP occurred annually,and the mortality of hospitalized patients being up to 14%.Therefore,a number of diagnosis and treatment guidelines of CAP based on epidemiological surveys on etiological pathogens were published and revised at regular intervals in many developed countries.These guidelines play an important role in the improvement of diagnosis,treatment and prognosis of CAP,as well as reducing the misuse of antibiotics.Data from global studies indicate that S.pneumoniae is still the major pathogen of CAP,however ,atypical pathogens such as Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophilia also play an important part.The nonsusceptible strains of S.pneumoniae to penicillin have been increasing in recent years.Up to now,an overall investigation on etiological pathogens of CAP and the surveillance of resistance pattern on respiratory pathogens are still lacking in this country.In addition, some limited local surveillance data showed that the susceptibility pattern of CAP pathogens in China including the resistance rates of S. pneumoniae to penicillin and macrolides and the rate of β-lactamases production in H.influenzae were not the same as reported in other countries. A guideline on the diagnosis and treatment of CAP had been worked out by the Chinese Society for Respiratory Diseases in 1998. Because of continuing changes of the respiratory pathogens and their resistance patterns , it is important to get new informations on these subjects for the purpose of revising and improvement of this guideline.This is a comprehensive study using a wide range of diagnostic tests to identify the etiological pathogens in CAP, including both typical pathogens (such as S.pneumoniae,and H.influenzae et al) and atypical pathogens(such as M.pneumoniae, C.pneumoniae and L.pneumophilia).At the same time, we evaluated the efficacy and safety of two regimens for the treatment of CAP, i.e. azithromycin monotherapy vs cefuroxime±erythromycin,under the guidance of GCP principles. The results of this study will provide scientific data for the revision of new CAP guidelines suitable for the clinical practice in China. There are two parts in this study:Investigation on etiology of community-acquired pneumonia in Shanghai.This part is designed to investigate the distribution of CAP pathogens in Shanghai, including typical and atypical pathogens, and test the susceptibility of these pathogens.Clinical evaluation of anti-infective trerapeuic regimens for CAPThis part is designed to evaluate the efficacy and safety of two antimicrobial regimens frequently used in foreign countries: a newer macrolide (azithromycin) monotherapy versus a β-lactam antibiotic (cefuroxime) with or without a macrolide (erythromycin).Part one: Investigation on etiology of community-acquired pneumonia in ShanghaiImmunocompetent patients with CAP (N=389, ≥2 years of age) were enrolled in the study from 5 hospitals in shanghai from October 2001 to September 2003. Demographic data and medical history were collected. Bacterial culture, PCR, and specific serum antibody test kits were employed to detect potential pathogens (bacteria and atypical pathogens) in respiratory tract specimens (sputum, pharyngeal swab), blood and urine samples. All isolates were tested against a selected panel of antimicrobial agents that are commonly used to treat CAP.Specific infecting pathogens were identified in 207 patients (including 30 with mixed infection caused by bacteria and atypical pathogen). Bacterial infection was confirmed in 114 cases and atypical infection in 123 cases. The most common typical bacteria were: Hemophilus spp. (20.6%), Klebsiella spp. (3.9%), S. pneumoniae (3.1%), Staphylococcus spp. (1.8%), Moraxella catarrhalis and other gram-negative bacteria (2.6%). The most frequently identified atypical pathogens were M. pneumoniae (24.2%), C. pneumoniae (8.2%), and Legionella pneumoph...
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