医院获得性肺炎病原菌耐药性及危险因素分析.pdfVIP

Chin J Nosocomiol Vo1．18 No．4 2008 · 论 著 · 医院获得性肺炎病原菌耐药性及危险因素分析 杨文杰，陶家驹 (天津市第一中心医院呼吸科，天津 300192) 摘要：目的 了解医院获得性肺炎(HAP)的病原菌和耐药状况，HAP发生时间对病原菌分布的影响，以及耐药 菌感染的危险因素。方法 收集患者下呼吸道分泌物进行定量培养和药敏试验，比较早发与晚发 HAP、轻中度 与重度HAP的病原菌以及先前抗菌药物应用对病原菌耐药性的影响。结果 HAP发病率为 l_O4 ，早发 HAP以革兰阳性球菌为主(64．29 )，晚发 HAP以革兰阴性杆菌为主(66．18 )；病原菌对大多数常用抗菌药 物耐药，晚发、重症HAP耐药菌分离率更高(PO．05)。结论 HAP多发生于合并多种基础疾病的老年患者， 大多数在发生HAP前应用过广谱抗菌药物，耐药菌比例较高；住院时间延长、前期应用广谱抗菌药物、重症肺炎 是耐药菌感染的危险因素。 关键词：医院获得性肺炎；病原菌；抗菌药物；耐药性 中图分类号：R378 文献标识码：A 文章编号：l005-4529(2008)04-0586-03 Etiology of Hospital Acquired Pneumonia and Risk Factors for Drug Resistance YANG Wen-jie。TAO Jia-jiu (Tianjin First Central Hospital，Tia in 300192，China) Abstract：0BJECTIVE To investigate the pathogens of HAP and their drug resistance in our hospital，the impact of duration of hospitalization on etiology， and the risk factors for the resistant pathogens． METHODS The respiratory tract secretion was collected from HAP patients tO culture and analyze the susceptibility of antimicrobi— als，compare the etiology of early-onset and late-onset HAP including prior antibiotics exposure and severity of HAP tO drug resistant bacteria．RESULTS During the period of study，there were 1．04 of patients suffering from HAP．Early-onset HAP was commonly caused by G Cocci while the main agents of late-onset HAP were G—bacilli．Most of the HAP pathogens were resistant tO the antimicrobials commonly used in clinic with the prior antimicrobials exposure and the severe HAP increased the resistant bacteria rate(P0．05)．CONCLUSIONS HAP occures at a rate of 1．04％ in our hospita1．Most of the patients are old with several underlying diseases and