隐匿性起病的老年人院内获得性肺部感染临床分析

Clinical Analysis of Atypical Hospital acquired Pneumonia in Elder

目的探讨以隐匿性起病的老年人院内获得性肺部感染的致病菌分布和临床特点。方法回顾分析67例隐匿性起病的老年人院内获得性肺部感染病例。结果病人肺部感染临床表现不典型,无咳嗽或轻微咳嗽者60例;无发热35例,低热(≤37.5℃)22例;谵妄36例,腹痛和腹泻26例。致病菌主要有革兰氏阴性细菌(61.0%)、革兰氏阳性细菌(26.4%)、真菌(12.6%)。25.3%的菌株产生细菌耐药性,选用敏感抗生素及进行综合处理,63例肺部感染得到控制,4例死于多器官功能衰竭。结论老年人院内获得性肺部感染可呈隐匿性发病,咳嗽、高热等症状不典型,以谵妄、腹痛等为主要表现,部分病变凶猛。革兰氏阴性菌、革兰氏阳性菌和真菌为主要致病菌,产生细菌耐药性高。治疗需选用敏感抗生素和综合处理。

Objective To investigate the distribution of bacteria and clinical treatment of atypical hospital acquired pneumonia in elderly. Method 67 cases ere analyzed retrospectively. Results 60 cases without coughing or little coughing, 35 cases without fever, 22 cases with mild fever (≤37.5℃), 36 cases had delirium symptoms while 26 cases had diarrhea. In the sputum culture test, G-, G+ and Fungus were 61.0%, 26.4%, and 12.6% respectively. After treatment, 64 cases recovered but 4 cases died of multiple organ functional failure. Conclusion There are seldom patients have severe cough and hyperpyrexia symptoms. G-,G+ and Fungus are the most important pathogens. The antimicrobial combined with general support treatments are benefit to the patients.