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糖尿病患者院内获得性非发酵菌肺炎92例临床分析

Non-fermentative bacilli associated with hospital-acquired pneumonia in diabetes patients:Clinical analysis of 92 cases
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摘要 目的探讨糖尿病患者非发酵革兰阴性杆菌院内获得性肺炎患者的病原学特点及细菌耐药情况,探索循证用药和预防。方法回顾性收集2001年12月至2008年4月呼吸内科住院病人中,糖尿病患者并发非发酵革兰阴性杆菌的院内获得性肺炎(HAP)的患者92例,并进行相关统计分析。结果 92例糖尿病非发酵菌HAP患者均伴有基础疾病和诱发因素,占同期呼吸内科住院患者1.2%,占并发糖尿病的院内获得性肺炎患者的56.1%。非发酵菌包括铜绿假单胞菌(31.5%),鲍曼不动杆菌(29.3%),洛菲不动杆菌(17.4%),嗜麦芽窄食单胞菌(9.8%),洋葱假单胞菌(8.7%),荧光假单胞菌(3.3%)。药敏结果为以上非发酵菌对常用广谱抗生素普遍耐药,尤其对第三代头孢菌素具有较高的耐药率,而对第四代头孢菌素、加酶抑制剂和亚胺培南耐药率较低。结论糖尿病并发非发酵菌HAP的患者多伴随有其他基础疾病,死亡率高,要及早预防,严格控制血糖,病原学检查和循证性选用抗生素均非常重要。 Objective To investigate the pathogenic features and bacterial resistance of non-fermentative bacilli associated hospital-acquired pneumonia(HAP) for the sake of prevention and Evidence-based Medicine treatment of this condition.Methods A retrospective review was made in 92 diabetes patients admitted from December 2001 to April 2008 who acquired non-fermentative bacilli associated HAP during hospital.Results All 92 patients who contracted non-fermentative bacilli associated HAP had underlying diseases and contributing factors.All these patients was 1.2% of the patients admitted in respiratory diseases department;and 56.1% of the HAP patients who had diabetes in the corresponding time period.Pseudomonas aeruginosa was detected in 29 patients(31.5%),Acinetobacter baumanii in 27 patients(29.3%),Acinetobacter Lwoffii in 16 patients(17.4%),stenotrophomo-nas maltophilia in 9 patients(9.8%),Pseudomonas cepacia in 8 patients(8.7%),Pesudomonas fluorescen in 3 patients(3.3%).Drug sensitivity test showed that the condition was multi-drug resistant,especially to the third generation cephalosporins.Enzyme-inhibitors,the fourth-generation cephalosporins and Imipenem were tested sensitive.Conclusions Nearly all diabetes patients with non-fermentative bacilli associated HAP had multiple underlying disease,with high mortality.Early preventions and rigorously controlling the level of blood glucose are of primary importance,and both pathogenic examination and Evidence-based Medicine treatment of antibiotics is essential for better prognosis.
出处 《临床肺科杂志》 2010年第12期1750-1752,共3页 Journal of Clinical Pulmonary Medicine
关键词 糖尿病 医院获得性肺炎 革兰阴性菌感染 diabetes mellitus hospital acquired pneumonia gram-negative bacterial infections
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