卫生保健相关性肺炎的临床分析

Clinical analysis of healthcare-associated pneumonia

目的探讨卫生保健相关性肺炎(HCAP)在我院的发病情况及临床特点。方法回顾性研究我院2007年1月—2008年4月的连续性肺炎住院患者。结果符合HCAP 75例,占本组肺炎的26.4%,对照社区获得性肺炎(CAP)133例、医院获得性肺炎(HAP)76例。HCAP的发生主要有反复住院(47例)、门诊输液(27例)、化疗或抗生素应用(27例)等因素;合并基础疾病71例(94.7%),显著高于CAP(37.6%,P<0.01),与HAP相似(88.2%,P>0.05);HCAP的细菌学特点:痰标本阳性率(56.9%)和细菌耐药性与HAP相似(P>0.05);起始抗菌药治疗有效47例(62.6%),34例病原学阳性病例中,起始抗菌药能够覆盖病原的18例(52.9%);HCAP死亡9例(12.0%),高于CAP(P<0.05),与HAP比较差异无统计学意义(P>0.05)。结论HCAP的发生与医疗环境有密切相关,是一种常见的肺炎,临床具有合并症多、细菌耐药性高和预后较差的特点,抗生素的选择要兼顾医院感染病原菌。

Objective To study the clinical characteristics of heahhcare-associated pneumonia （HCAP）. Methods A retrospective cohort study was conducted on consecutive hospitalized pneumonia cases from January 2007 through April 2008. Results HCAP group of 75 patients was compared with 133 patients of community-acquired pneumonia （CAP） and 76 patients of hospital-acquired pneumonia （HAP）. Most of HCAP patients had a history of recent hospitalization （47 cases）, clinical Ⅳ infusion （27 cases）, and prior chemotherapy or antibiotic therapy （27 cases）. Underlying diseases were identified in 71 （94.7%） of HCAP patients, significantly higher than that in CAP group （37.6%, P〈0.01）. Positive sputum culture in CAP, HCAP and HAP was 22.6%, 56.9%, 77.6% respectively. Antibiotic resistance of bacteria in HCAP （71.43%） and HAP （80%） was comparable （P〉0.05）. Initial antibiotic therapy was effective in 47 （62.6%） cases of HCAP. Only 52.9% of the identified pathogens were sensitive to initial antibiotic therapies. The mortality of HCAP （12%） was similar to HAP （23%, P〉0.05）, but significantly higher than CAP （3%, P〈0.05）. Conclusions HCAP is a common type of pneumonia, which is characterized by more resistant pathogens, higher mortality, more comorbidities and poor outcomes. Antibiotic therapy should cover the hospital acquired bacterial pathogens.