2819例医院下呼吸道感染病原和预后分析

Pathogens and prognosis of 2819 nosocomial lower respiratory tract infection

目的 了解医院下呼吸道感染 (NLRTI)的病原菌和预后特点。方法 以我院 1998年 7月～ 2 0 0 3年 6月间的住院患者为对象 ,监测、统计并分析NLRTI的病原菌和预后情况。结果 5年间共出院 1182 15例 ,发生NLRTI 2 819例次 ,平均发病率为 2 .4 %。按科室计 ,以血液科 ( 8.3% )、神经外科 ( 7.3% )、神经内科( 7.0 % )和呼吸科 ( 4 .3% )较高。NLRTI最常见的前 5位病原菌依次为金黄色葡萄球菌 ( 2 3.2 % )、鲍曼不动杆菌 ( 2 2 .1% )、铜绿假单胞菌 ( 17.1% )、克雷伯菌 ( 7.7% )和阴沟肠杆菌 ( 5 .0 % )。分别以 3种不同的阳性判断标准 :≥ 1+、≥ 2 +、≥ 3+对标本培养结果进行分析 ,病原菌构成比的差异均无显著性 (P >0 .0 5 )。不同科室病原菌分布的差异有显著性 (P <0 .0 5 ) ,金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌分别在神经内科、呼吸科和血管外科、心外科和血管外科的构成比最高。重症监护病房 (ICU)与普通科室相比较 ,鲍曼不动杆菌、沙雷菌属细菌在ICU的构成比显著高于普通科室 (P <0 .0 5 )。NLRTI组平均病死率为 17.7% ,无NLRTI组仅为 1.9% ,死亡的比值比 (OR)为 9.4 ( 95 %CI =8.6～ 10 .2 ) ,以骨科 ( 10 9.9)、泌尿科 ( 74 .7)和胸外科 ( 16 .7)较高。 6 5～ 79岁、≥ 80岁与 <6

Objective To investigate the pathogens and prognosis of nosocomial lower respiratory tract infection (NLRTI). Methods The data of pathogen spectrum and mortality of NLRTI patients in Zhongshan hospital from Jul 1998 to Jun 2003 was analyzed retrospectively. Results Among the 118 215 hospitalized patients, 2 819 patients had NLRTI, the incidence was 2.4%. Among the various departments of the hospital, department of hematology ranked the highest (8.3%), followed by departments of neurosurgery (7.3%), neurology (7.0%) and pulmonology (4.3%) . The most common pathogens of NLRTI were Staphylococcus aureus (23.2%), followed by Acinetobacter baumannii (22.1%), Pseudomonas aeruginosa (17.1%), Klebsiella spp. (7.7%) and Enterobacter cloacae (5.0%) . The proportion of pathogens were different in different departments. The mortality in NLRTI group was 17.7%, much higher than that of the non NLRTI group (1.9%). The average odds ratio (OR) of NLRTI was 9.4(95%CI=8.6～10.2), which was higher in the departments of orthopedics (109.9), urology (74.7) and thoracic surgery (16.7). The OR of patients' age between 65～79 and ≥80 were 1.5(95% CI=1.2～1.7)and 2.1 (1.7～2.6), respectively. Conclusion Nosocomial lower respiratory tract infection is commonly seen in the hospitalized patients, the incidence is high. The most common NLRTI encountered are Staphylococcus aureus and nonfermentative gram negative bacilli, whereas the proportion of Enterobacteria is lower. NLRTI is an important cause of hospital mortality, specially among the elderly.