成人社区及医院获得性肺炎病原菌及耐药性差异  

Difference in pathogens and antimicrobial resistance in community-acquired and hospital-acquired pneumonia in adults

作　　者：谭善娟[1] 毕俏杰[2] 李玲[1] 张磊[1] 张晓 吕维红[1] TAN Shan-juan;BI Qiao-jie;LI Ling;ZHANG Lei;ZHANG Xiao;LV Wei-hong(Department of Healthcare-associated Infection Management,Qingdao Municipal Hospital,Qingdao 266071,China;Department of Emergency, Qingdao Municipal Hospital, Qingdao 266071, China)

机构地区：[1]青岛市市立医院医院感染管理科,山东青岛266071 [2]青岛市市立医院急诊科,山东青岛266071

出　　处：《中国感染控制杂志》2020年第9期835-842,共8页Chinese Journal of Infection Control

摘　　要：目的比较非呼吸机相关医院获得性肺炎(NV-HAP)、呼吸机相关肺炎(VAP)与社区获得性肺炎(CAP)感染病原菌分布及耐药性。方法回顾性调查2017年10月—2019年9月某院肺炎患者病历资料,按NV-HAP、VAP、CAP定义将患者分别列为NV-HAP组、VAP组、CAP组。收集三组患者痰、支气管肺泡灌洗液、血标本培养病原菌及药敏试验结果,分析三组患者感染病原菌构成和耐药性差异。结果共纳入肺炎患者4391例,NV-HAP组1080例,VAP组126例,CAP组3185例,各组分别检出病原菌841、191、1440株,均以革兰阴性(G-)菌为主,依次占72.77%、84.82%和61.18%,三组患者检出病原菌分布比较,差异有统计学意义(χ2=64.037,P<0.001)。鲍曼不动杆菌对头孢吡肟、头孢哌酮/舒巴坦、亚胺培南、庆大霉素、妥布霉素、左氧氟沙星、环丙沙星和复方磺胺甲口恶唑耐药率,铜绿假单胞菌对头孢哌酮/舒巴坦和亚胺培南耐药率,肺炎克雷伯菌对常用抗菌药物耐药率,三组比较差异均有统计学意义(均P<0.05);金黄色葡萄球菌对红霉素、克林霉素和环丙沙星的耐药率比较,CAP组高于NV-HAP组(P<0.05)。结论NV-HAP、VAP和CAP在病原菌分布及细菌耐药性方面均存在差异,在制定临床治疗方案时,要区别对待不同感染类型的肺炎。Objective To compare the distribution and antimicrobial resistance of pathogens in non-ventilator hospital-acquired pneumonia(NV-HAP),ventilator-associated pneumonia(VAP)and community-acquired pneumonia(CAP).Methods Medical records of patients with pneumonia in a hospital from October 2017 to September 2019 were retrospectively investigated,according to the definition of NV-HAP,VAP and CAP,patients were divided into NV-HAP group,VAP group and CAP group.Sputum,bronchoalveolar lavage fluid and blood specimens were collected from three groups,difference in constituent and antimicrobial resistance of pathogens of three groups were analyzed.Results A total of 4391 patients with pneumonia were included,including 1080 cases in NV-HAP group,126 in VAP group and 3185 in CAP group,841,191 and 1440 strains of pathogens were isolated from each group,mostly were Gram-negative bacteria,accounted for 72.77%,84.82%and 61.18%respectively,difference in distribution of pathogens isolated from three groups was statistically significant(χ2=64.037,P<0.001).Antimicrobial resistance rates of Acinetobacter baumannii to cefepime,cefoperazone/sulbactam,imipenem,gentamicin,tobramycin,levofloxacin,ciprofloxacin and compound sulfamethoxazole,resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam and imipenem,as well as resistance rates of Klebsiella pneumoniae to commonly used antimicrobial agents among three groups were all statistically significant(all P<0.05);resistance rates of Staphylococcus aureus to erythromycin,clindamycin and ciprofloxacin in CAP group were all higher than in NV-HAP group(P<0.05).Conclusion NV-HAP,VAP and CAP are different in pathogenic distribution and antimicrobial resis-tance,in the formulation of clinical treatment program,different types of pneumonia should be treated differently.

关 键 词：医院获得性肺炎 非呼吸机相关医院获得性肺炎 呼吸机相关肺炎 社区获得性肺炎 病原菌 耐药性 

分 类 号：R181.32[医药卫生—流行病学]