神经内科医院内获得性肺炎经验性治疗研究

Hospital-acquired pneumonia:Importance of recognition of aetiological agents to difine an appropriate initial empirical therapy

目的:探讨神经内科住院病人医院内获得性肺炎(HAP)病原体构成及抗菌药物敏感性的差异。方法:对我院神经内科2002年1月～2006年8月发生的HAP病人记录致病菌药敏试验结果。结果:共有202例病人,其中62%住院治疗后5天发展为肺炎。早发肺部感染以金黄色葡萄球菌(17.8%)和肺炎克雷伯杆菌(33.3%)为主,晚发以不动杆菌属(34.9%),铜绿假单胞(25.4%)和金黄色葡萄球菌(19.8%)为主。左氧氟沙星的敏感性75%,晚期为60%,亚胺培南敏感性90%,晚期为78%,万古霉素加亚胺培南早期敏感性100%,晚期为95%。结论:单一的左氧氟沙星能够覆盖早发医院内获得性肺炎致病菌,最好的联合治疗是万古霉素加亚胺培南。

Objective：To study the difference of pathogen constitution and antibioticc sensitivety in in-patients with hospital-aquired pneumonia （HAP） in the department of neurology.Methods：The in-patients suffering from HAP from January 2002 to August 2006 in the nerology department of Huizhou hospital were collected in this study,and the diagnosis of HAP was made based on the respiratory specimen cuhure.The clinical data including the time of HAP onset, severity of illness,risk factors,isolated bacteria and antimicrobial sensitivity were analysed retrospectively.Resuits：A total of 202 patients with HAP were recruited,the most common pathogen of lung infection in early onset was ldebsiella pneumoniae （33.3%） and staphylococcus aureus （17.8%）,while in alte onset it was Acinetobaeter baumanii （34.9%）, Pseudomonss aeruginosa （25.4%） and staphylococcus aureus （19.8%）.Levofloxacin was the best monotherapy for early and late onset pneumonia （75% and 60% respetively）.The sensitivity of imipenem plus vancomycin was 100% in early onset pneumonia and 95% in late onset one.Condusion：Monotherapy with levofloxacin or the combined treatment of imipenem and vancomycin may be good option ad initial empirical therapy for the hospital-aquired pneumonia.the later is the best.