医院获得性肺炎患者基础疾病及病原学分析  

Analysis of clinical characteristics of medical hospital acquired pneumonia

作　　者：何牡丹[1] 

机构地区：[1]上海市第一人民医院宝山分院呼吸科,上海200940

出　　处：《临床肺科杂志》2014年第4期668-670,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的 了解内科住院病人中医院获得性肺炎（Hospital Acquired Pneumonia HAP）的基础疾病、病原学分布及药物敏感特点,指导临床工作,改善患者预后.方法 回顾性研究2012年1月~2012年12月之间192例内科HAP患者的临床资料.结果 HAP患者均存在1种或多种基础疾病,其中以脑血管意外、2型糖尿病、心肺疾病、营养不良、恶性肿瘤及慢性肾功能不全为主.病原学以G-菌常见,常见G-菌对β内酰胺酶抑制剂复合物、碳青酶烯类、氨基糖苷类及喹诺酮类较敏感,部分菌株出现了多药耐药.G＋菌主要为金黄色葡萄球菌,70%为耐甲氧西林金黄色葡萄球菌（MRSA）,MRSA对万古霉素、利奈唑胺、呋喃妥因敏感.结论 HAP病原菌以G-为主,出现了耐多药菌株,对HAP的高危患者应予以重点关注,并采取相应的防治措施,及早监测,根据本医疗机构致病菌情况进行治疗,控制耐药菌的传播,改善患者预后.Objective To study the basic disease of HAP and to investigate the distribution of etiology and drug resistance of medical hospital acquired patients. Methods The clinical data of 192 patients with HAP in the medical Department were retrospectively studied and analyzed. Results All HAP patients were with primary diseases. Brain vascular accident ranked the first, followed by Type 2 Diabetes Mellitus, cardiac and pulmonary diseases, malnutrition, cancer and chronic kidney insufficiency. Gram-negative bacteria were the major pathogen. Common Gram-negative bacteria were relatively sensitive to β-Lactamase inhibitor compounds and carbapenems and aminogly-cosides and quinolones. Some strains were multiple drug resistant （MDR） strain. Staphylococcus aureus were the major Gram-positive pathogen and 70% of them were methicillin resistant. MRSA was sensitive to vancomycin, linezolid and nitrofurantoin. Conclusion Gram-negative bacteria are the major pathogen of HAP and some of them are MDR strain. More attention should be paid to the high risk patients. The prevention and treatment of infection should be strictly controlled. The treatment of HAP should take the pathogen and drug resistance of medical institution into consideration.

关 键 词：医院获得性肺炎 基础疾病 致病菌 耐药性 

分 类 号：R563.1[医药卫生—呼吸系统]