社区获得性肺炎患者初始经验治疗失败时，临床常规根据痰培养及药敏试验结果选择抗生素，尤其是多次痰培养均为同一种细菌生长时，临床常把该结果作为选择抗生素的风向标。然而，受送检的痰液质量及实验室技术人员主观因素的影响，痰培养检出的优势菌不一定是致病菌。本文报道1例社区获得性肺炎患者，痰培养结果提示存在多种革兰阴性杆菌，但抗革兰阴性杆菌治疗无效，综合患者临床特征后，改为抗球菌治疗，患者体温恢复正常。当患者痰培养结果与临床特征不符时，临床医生不能盲目信任检查结果。如不存在误诊、特殊病原体感染、并发症、免疫抑制等情况，且充分抗杆菌（已覆盖耐药菌）治疗无效时，可实施抗球菌治疗。%When initial experiential therapy of community acquired pneumonia patients fails,we routinely choose drugs according to sputum culture and drug susceptibility results;especially when multiple sputum cultures showed the same kind of bacteria growing,we often take this result as the indicator of choosing antibiotics. However,influenced by the quality of sputum inspected and subjective factors of laboratory staff,the dominant bacteria cultured may not be pathogenic bacteria. The paper reported a case of community acquired pneumonia patients. In this case,the sputum culture results suggest many kinds of gram negative bacteria,and the anti gram negative bacilli treatment showed no efficacy;referring to clinical features of patients, the treatment was transferred to anti - coccus treatment,after which the body temperature of the patient returned to normal. When unconformity occurs between sputum culture and clinical features,clinical doctors should not strictly follow diagnosis results. If no misdiagnosis,special pathogenic infection,complication and immunosupression exist and the full anti - bacillus treatment(covering drug - resistant bacteria)is not effective,anti - coccus treatment could be undertaken.
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