医疗机构相关性肺炎病原学特征分析

Analysis on etiology characteristics of health care-associated pneumonia

目的 分析医疗机构相关性肺炎（HCAP）的病原菌特征,以提高其治疗效果.方法 回顾性收集我院284例住院肺炎患者资料,比较HCAP和社区获得性肺炎（CAP）病原菌感染情况.结果 284例肺炎患者（CAP组183例,HCAP组101例）共培养出病原菌487株;CAP组前五位病原菌为肺炎链球菌43株（32.6％）,肺炎支原体24株（18.2％）,流感嗜血杆菌19株（14.4％）,铜绿假单胞菌8株（6.1％）,金黄色葡萄球菌4株（3.0％）;HCAP组前五位病原菌为铜绿假单胞菌121株（34.1％）,金黄色葡萄球菌57株（16.1％）,鲍曼不动杆菌50株（14.1％）,肺炎克雷伯菌31株（8.7％）,大肠埃希菌25株（7.0％）;HCAP组培养出革兰阴性杆菌288（81.1％）株,革兰阳性球菌67（18.9％）株,革兰阴性杆菌和革兰阳性球菌中又分别以铜绿假单胞菌[121株（42.0％）]和金黄色葡萄球菌[57株（85.1％）]最为常见.结论 HCAP病原菌种类不同于CAP,提高对HCAP病原菌种类的认识可为合理初始经验性抗生素治疗提供可靠的依据.

Objective To improve the effect of treatment by analyzing the etiology characteristics of health care-associated pneumonia （HCAP）.Methods The data of 284 patients with pneumonia were collected,the etiology characteristics of HCAP and community-acquired pneumonia （CAP） were compared.Results In 284 cases of patients with pneumonia,487 strains of pathogens were isolated.In the CAP group,the top five pathogens were Streptococcus pneumoniae [43 strains （32.6％）],Mycoplasma pneumoniae [24 strains （18.2％）],Hemophilus influenzae [19 strains （14.4％）],Pseudomonas aeruginosa [eight strains （6.1％）],and Staphylococcus aureus [four strains （3.0％）].In the HCAP group,the top five pathogenic bacteria were Pseudomonas aeruginosa [121 strains （34.1％）],Staphylococcus aureus [57 strains （16.1％）],Bauman Acinetobacter [50 strains （14.1％）],Klebsiella pneumoniae [31 strains （8.7％）],and Escherichia coli [25 strains （7.0％）].In the HCAP group,288strains （81.1％） were gram negative bacilli,67 strains （18.9％） were gram positive cocci,in which Pseudomonas aeruginosa [121 strains （42.0％）] and Staphylococcus aureus [57 strains （85.1％）] were the most common.Conclusions The pathogenic bacteria of HCAP is different from CAP,we should improve the understanding of the pathogenic bacteria in HCAP,which provides the reliable basis for the use of antibiotics.