老年患者医院获得性肺炎病原学及危险因素研究

Clinical epidemiological analysis of hospital-associated pneumonia in senile patiens in Guangzhou strict

目的对老年患者医院获得性肺炎（HAP）致病菌的构成及耐药情况、危险因素进行研究，以期指导临床防治。方法对≥60岁HAP患者226例，进行致病菌的分离鉴定，采用纸片扩散法检测细菌药敏情况，对老年HAP及其致病菌、预后采用Logistic回归进行危险因素分析。结果老年HAP前十种致病菌分别为：铜绿假单胞菌（16．1％），金黄色葡萄球菌（14．6％），肺炎克雷伯菌（10．2％），大肠埃希菌（8．8％），溶血葡萄球菌（7．3％）。金黄色葡萄球菌中MRSA比例高达90％，铜绿假单胞菌对亚胺培南耐药率为29．5％。老年患者发生HAP的高危因素依次为：急性脑血管意外、低白蛋白血症、气管插管或机械通气、肾功衰竭、COPD、留置胃管、贫血、肝功能异常、住院时间长（均P〈0．05）。老年HAP患者死亡率为29．2％。结论老年患者HAP细菌耐药性严重，死亡率高，必须加强危险因素干预。

Objective To determine the distribution and antibiotic resistance of hospital - associated pneumonia（HAP） in senile patient, and the high risk factors of HAP,pathogenic bacterium and prognosis, so as to instruct the clinic prevention and treatment. Methods Patients with age over 60 years old,who were diagnosed of HAP with confirmed pathogens. Pathogens were identified, then the antibiotic resistance was determined by Kirty-Baueer disk diffusion assay. High risk factors of HAP,pathogenic bacterium and prognosis were analyzed by Logistic regression analysis. Results The first 10th pathogens of HAP patients were pseudomonas aeruginosa（ 16. 1% ）, staphylococcus aureus （ 14.6% ）, klebsiella pneumonia（ 10.2% ）, escherichia coli （ 8.8% ）, staphylococcus hemolyticus （7.3%）. MR- SA accounted for 90% in staphylococcus aureus. The drug resistance of pseudomonas aeruginosa to imipenem was 29. 5%. The high risk factors of HAP were acute brain accident,hypoalbuminemia,tracheal intubation or mechanical ventilation, rennal failure, COPD, gastric tube, anaemia,liver disfunction,long length of stay （ all P 〈 0.05 ）. The mortality of senile HAP was 29.2%. Conclusion There are high antibiotic resistance and high mortality of HAP in senile patients. Measures should be taken to modify the risk factors.