老年心衰患者医院获得性肺炎病原学流行病学调查

Hospital acquired pneumonia in elderly patients with heart failure etiology epidemiology

目的调查我院心内科收治的心衰患者医院获得性肺炎（hospital-acquired pneumonia,HAP）病原体流行病学特点,探究其诱发因素及防治措施。方法对我院心内科2007年4月~2012年2月所收治的心衰患者中76例发生医院获得性肺炎的病例进行回顾性分析。标本为无菌生理盐水漱口后采集的晨痰,气管插管或气管切开者用灭菌吸痰管集痰器吸取呼吸道分泌物送检细菌培养及药敏试验,药敏试验采用纸片法。结果常见的病原菌为革兰阴性菌（60.52%）,以铜绿假单胞菌、肺炎克雷伯杆菌、鲍氏不动杆菌为主,药敏试验易出现多重耐药菌株。革兰阳性菌（31.57%）中,以MSSA,MSSE为主,MRSA感染亦有发生,但均对万古霉素敏感。真菌感染为白色念珠菌（5.92%）,均对达夫康（氟康唑）敏感。结论心衰患者HAP常见的诱发因素为长期卧床,营养不良,昏迷,机械通气,呕吐物误吸,近期受凉感冒,上呼吸道感染,不愿意咳嗽,抗生素的不正规使用以及护理不当等。针对其危险因素我们应积极采取有效的控制措施,尽快恢复患者意识及呼吸道防御机制,减少肠道细菌移位,保持呼吸道通畅,规范合理应用抗生素,加强扣背等护理,加强全身支持治疗是防治HAP的关键,同时,动态监测病区病原体流行病学状况,指导抗生素经验性治疗以及抗生素轮替策略,对降低多重耐药菌的产生有积极意义。

Objectives To investigate heart failure patients admitted to the hospital＇s Cardiology hospital-acquired pneumonia （HAP） pathogen epidemiological characteristics, to explore the predisposing factors and preventive measures. Methods The pa- tients with heart failure in our hospital in April 2007 - February 2012 occurred in 76 cases of hospital-acquired pneumonia were ret- rospectively analyzed. After the specimen is collected sterile saline mouthwash morning sputum, endotracheal intubation or tracheoto- my absorb respiratory secretions sterile suction tube collector sputum is submission bacterial culture and sensitivity test, susceptibility testing by disk law. Results The common pathogens Gram-negative bacteria （60. 52% ）, Pseudomonas aeruginosa, Klebsiella pneu- moniae, Acinetobacter baumannii mainly susceptibility testing prone to multiple drug-resistant strains. Gram-positive bacteria （31.57% ） in order to MSSA, MSSE based, MRSA infections also occur, but are sensitive to vancomycin. Candida albicans fungal in- fection （5.92%） ,are on the Da Fukang （fluconazole） sensitive. Conclusions The HF patients HAP common predisposing factor for the bedridden, malnutrition, coma, mechanical ventilation, aspiration of vomit, recently catching a cold, upper respiratory tract in- fection, unwilling to cough, irregular use of antibiotics and improper care; for the risk factors we should take effective control meas- ures to restore the patient consciousness and respiratory tract defense mechanisms as soon as possible,to reduce bacterial transloca- tion, keep the airway open, standardized rational use of antibiotics, strengthen buckle back and other treatments, and systemic support treatment is prevention and treatment of HAP the key, at the same time, dynamic monitoring of the epidemiological situation ward pathogens guide empirical antibiotic therapy and antibiotic rotation strategies to reduce the generation of multi-resistant bacteria has a positive meaning.