上海市二级医院医院获得性肺炎150例临床分析

Hospital acquired pneumonia in Grade Ⅱ hospitals in Shanghai:a clinical analysis of 150 cases

目的分析上海市二级医院医院获得性肺炎（HAP）的临床特点。方法对上海市14所二级医院150例HAP患者的临床资料进行回顾性分析。结果患者年龄34~96岁,男87例,女63例。早发HAP36例（24.0%）,晚发HAP 114例（76.0%）。发热124例（82.7%）,有咳嗽、咳痰等呼吸道症状148例（98.7%）,有乏力、纳差等非特异性症状48例（32.0%）。血常规：白细胞计数升高（≥10×109/L）78例（52.0%）,白细胞计数正常而中性粒细胞升高42例（28.0%）,白细胞计数减少（≤4×109/L）7例（4.7%）,两者均正常23例（15.3%）。合并基础疾病139例（92.7%）,死亡27例（18.0%）。分离出致病菌152株,革兰阴性菌占86.6%,革兰阳性菌占13.4%。前5位致病菌依次为肺炎克雷伯菌（32株）、鲍曼不动杆菌（28株）、肺炎链球菌（22株）、铜绿假单胞菌（16株）和金黄色葡萄球菌（16株）。早发HAP致病菌主要为肺炎克雷伯菌、肺炎链球菌,晚发HAP致病菌主要为鲍曼不动杆菌、金黄色葡萄球菌和肺炎克雷伯菌。耐药菌占10.5%（16/152）,其中54.5%（12/22）的肺炎链球菌存在耐药。患者病情转归与肺部炎症范围有关,双肺炎症患者的病死率较高（χ2=17.361,P〈0.05）。结论革兰阴性菌是二级医院HAP的主要致病菌,除肺炎链球菌外总体耐药率不高,早期应用含有针对革兰阴性菌的抗生素有利于改善HAP的预后。

Objective To analyze the clinical characteristics of hospital acquired pneumonia（HAP） in Grade Ⅱ hospitals in Shanghai.Methods The clinical data of 150 HAP patients from 14 Grade Ⅱ hospitals in Shanghai were retrospectively analyzed.Results The 150 HAP patients included 87 males and 63 females,with a mean age of（65.03±8.42） years old and an age range from 34 to 96 years old.Thirty-six（24.0%） cases were diagnosed as having early-onset HAP,and 114（76.0%） had late-onset HAP.The main symptoms of HAP included fever（in 124 cases,82.7%）,cough and expectoration（in 148 cases,98.7%）,and fatigue and anorexia（in 48 cases,32.0%）.White blood cells were increased in 78 cases（52.0%）,neutrophils were increased in 42 cases（28.0%）,and both were normal in 23 cases（15.3%）.We found that 139 cases（92.7%） were accompanied with underlying diseases.Twenty-seven cases（18.0%）died from HAP.The top five bacteria in a total of 152 isolated pathogens were Klebsiella pneumoniae（32 cases,21.1%）,Acinerobacter baumannii（28 cases,18.4%）,Streptococcus pneumoniae（22 cases,14.5%）,Pseudomonas aeruginosa（16 cases,10.5%）,and Staphylococcus aureus（16 cases,10.5%）.Gram-negative bacteria（86.6%） were the dominant pathogens of HAP patients.Drug-resistant bacteria accounted for 10.5%（16/152）.Klebsiella pneumoniae and Streptococcus pneumoniae were the two main strains in early-onset HAP;Acinerobacter baumannii,Staphylococcus aureus and Klebsiella pneumoniae were the main strains in late-onset HAP.The drug resistant rate of Streptococcus pneumoniae was 54.5%（12/22）.Conclusions HAP is usually accompanied by underlying disease,and its clinical findings are similar with that of CAP.Gram-negative bacteria are the main pathogens of HAP in Grade Ⅱ hospitals in Shanghai.Drug-resistant rate of the bacteria is low except for Streptococcus pneumoniae.Early application of antibiotics for Gram-negative bacteria can improve the prognosis of HAP.