医院获得性肺炎危险因素及细菌耐药性分析

Hospital-acquired Pneumonia:Risk Factors and Resistance to Antibiotics

目的 探讨院内获得性肺炎感染危险因素、致病菌的分布特点及对抗生素的耐药性。方法 对临床确认的 95例院内获得性肺炎患者下呼吸道标本进行细菌鉴定和药敏试验 ;对其临床资料、试验结果进行回顾性分析。结果 95例院内获得性肺炎患者中年龄 >6 0岁者占 70 .5 % ;患各种严重基础疾病者占 10 0 % ;住院时间 >30d者占 6 8.4 % ;接受侵袭性操作者占 2 6 .3% ;分离出的 14 2株致病菌中革兰阴性杆菌感染占 88.0 % ,肺炎克雷伯菌 2 6 .8% ,ESBLs菌占 4 2 .1% ;大肠埃希菌 2 5 .4 % ,ESBLs占 38.9% ;鲍氏 /乙酸钙不动杆菌占 2 1.1% ;药敏结果显示 :产ESBLs菌在肺炎克雷伯菌和大肠埃希菌中比例极高并对多种抗生素交叉耐药 ,但对亚胺培南全部敏感。结论 在院内获得性肺炎的易感因素中严重基础疾病、高龄、长时间住院和侵袭性操作占前 4位 ;感染以革兰阴性杆菌为主 ;肺炎克雷伯菌和大肠埃希菌中产ESBLs菌对亚胺培南均敏感 ;有 10 .5

OBJECTIVE To search for risk factors of hospital acquired pneumonia and its pathogen distribution and resistance to antibiotics. METHODS Identification of bacteria in specimen and drug sensitivity test were performed,those specimens from the lower respiratory tract of 95 patients with HAP identified clinically. Retro analysis for test′s results and clinical data were carried out. RESULTS Among 95 patients 70.5% were more than 60 years old; 100% had a severe underlying diseases; 68.4% had hospitalized more than 30 days; 26.3% had been performed invasive operations. Gram negative bacilli accounted for 88.0% among 142 strains of bacteria in which 26.8% were Klebsiella pneumoniae (from them ESBLs producing bacteria accounted for 42.1%), Escherichia coli (ESBLs producing bacteria accounted for 38.9%) and Acinetobacter calcoaceticus with A. baumannii account for 25.4% and 21.1%, respectively. Drug sensitivity test′s results showed that ESBLs producing bacteria presented in high proportion of K. pneumoniae and E. coli and were cross resistant to various antibiotics but all sensitive to imipenem. CONCLUSIONS Among HAP′s risk factors there are four main factors that include the patients with serious underlying diseases, old of age, long duration of hospitalization and invasive operation performed; HAP are mainly caused by Gram negative bacilli; all ESBLs producing bacteria in K. pneumoniae and E. coli are sensitive to imipenem; 10.5% of the HAP patients accompany with fungus infection.