老年人医院获得性金黄色葡萄球菌肺炎分析

Retrospective analysis of hospital-acquired pneumonia caused by Staphylococcus aureus in elderly patients

目的探讨老年人金黄色葡萄球菌(金葡菌)肺炎的临床特点、危险因素,从而预防其在老年科病房的发生和流行。方法对我院老年科2005年1月至2006年8月医院获得性金葡菌肺炎患者临床资料进行回顾分析。结果老年金葡菌肺炎临床表现无特殊性,以耐甲氧西林金葡菌(MRSA)感染为主(79.3%)。MR-SA所致感染大多发生在免疫功能低下且伴有严重基础疾病的患者,医源性途径占重要地位,高龄、痴呆、意识障碍、入住ICU等是MRSA感染的高危因素。MRSA具有多重耐药性,万古霉素对其敏感性100%,仍是目前最有效的药物。结论控制MRSA的感染主要应切断医源性途径,积极进行病原学监测、及时发现病例、隔离和治疗患者、合理使用广谱抗生素、严格消毒隔离等。

Objective To investigate the clinical features and risk factors about methieillin-resistent Staphylococcus aureus （MRSA） in hospital-acquired pneumonia, and to prevent the epidemic of MRSA. Methods The hospitalized cases of Department of Geriatrics with hospital-aequired pneumonia caused by S. aureus from January 2005 to August 2006 were retrospectively analysed. Results Hospital-acquired pneumonia was mainly caused by MRSA （79. 3% ）. The important independent risk factors were primary serious disease and long-term hospitalization in ICU. Iatrogenie factors played an important role in MRSA infection. Vaneomyein remained to be the most sensitive antibiotic for MRSA. Conclusions The strategy to control MRSA infection is breaking the iatrogenie pathway. Monitoring etiology and isolating the patients infected by MRSA and using antibiotics reasonably and sterilizing strictly are effective measures.