上海地区成人医院获得性肺炎易患因素病原学及预后分析

A retrospective analysis of risk factor,pathogen and prognosis of hospitalacquired pneumonia in adult patients in Shanghai

目的本研究对上海地区医院获得性肺炎(HAP)的病原菌和临床结局进行前瞻性研究,探讨上海地区HAP的临床特点、易患因素、病原菌的耐药状况及对临床预后的影响因素。方法采用前瞻性观察性研究方法,收集2007年11月-2009年12月上海市7所大型综合性医院住院并确诊为HAP患者的临床资料及微生物学标本进行细菌培养、鉴定和药敏试验。结果本组共收集HAP 204例,患者平均年龄(68±17)岁,70岁以上患者占58.3%。患者的基础疾病有脑血管疾病、合并糖尿病、腹腔手术后等。20.6%为呼吸机相关性肺炎。病死率15.7%。心率增快、动脉血pH值下降、低氧、高血糖、血清尿素氮增高及使用血管活性药物与患者存活率降低相关。病原菌中革兰阴性杆菌占64.9%,MRSA检出率为65.4%,未发现万古霉素耐药的MRSA。结论高龄、脑血管疾病和糖尿病是HAP易患因素,并发感染性休克者预后差;常见HAP病原菌包括鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌和金葡菌,MRSA约占65.4%。

Objective To investigate the clinical features,risk factors,antibiotic resistance,and clinical outcomes of hospital-acquired pneumonia（HAP） in adult patients in Shanghai hospitals.Methods From November 2007 to December 2009,the clinical and microbiological data of HAP cases were prospectively reviewed in seven large general hospitals in Shanghai region.Results A total of 204 cases were included in the analysis.The mean age of these patients was（68±17） years（58.3%70 years）.The underlying conditions included cerebral vascular disease,diabetes mellitus and abdominal surgery.Ventilator-associated pneumonia accounted for 20.6%of the cases.The case mortality was 15.7%.Increased heart rate,decreased arterial PH,hypoxia,hyperglycemia,increased plasma creatinine and vasopressor use were associated with the poor outcome in these HAP patients.Of all the bacterial strains isolated from HAP,64.9%were gram-negative bacilli,including A. baumannii,P.aeruginosa,K.pneumoniae,and E.coli. The prevalence of methicillin-resistant Staphylococcus aureus was 65.4%in the S.aureus isolates.No vancomycin-resistant MRSA was identified.Conclusions Advanced age,cerebrovascular diseases and diabetes are risk factors of HAP. Septic shock is the most important complication associated with poor prognosis of HAP.Common pathogens of HAP include A.baumannii,P.aeruginosa,K.pneumoniae,E. coli,and S.aureus（MRSA 65.4%）.