中国感染与化疗杂志
中國感染與化療雜誌
중국감염여화료잡지
CHINESE JOURNAL OF INFECTION AND CHEMOTHERAPY
2009年
4期
256-259
,共4页
陈玉玲%邵华军%张文辉%陈昊
陳玉玲%邵華軍%張文輝%陳昊
진옥령%소화군%장문휘%진호
肺炎%细菌%抗菌药物
肺炎%細菌%抗菌藥物
폐염%세균%항균약물
healthcare-associated pneumonia%bacteria%antibiotic
目的 探讨卫生保健相关性肺炎(HCAP)在我院的发病情况及临床特点.方法 回顾性研究我院2007年1月-2008年4月的连续性肺炎住院患者. 结果 符合HCAP 75例,占本组肺炎的26.4%,对照社区获得性肺炎(CAP)133例、医院获得性肺炎(HAP)76例.HCAP的发生主要有反复住院(47例)、门诊输液(27例)、化疗或抗生素应用(27例)等因素;合并基础疾病71例(94.7%),显著高于CAP(37.6%,P<0.01),与HAP相似(88.2%,P >0.05);HCAP的细菌学特点:痰标本阳性率(56.9%)和细菌耐药性与HAP相似(P>0.05);起始抗菌药治疗有效47例(62.6%),34例病原学阳性病例中,起始抗菌药能够覆盖病原的18例(52.9%);HCAP死亡9例(12.0%),高于CAP(P <0.05),与HAP比较差异无统计学意义(P>0.05). 结论 HCAP的发生与医疗环境有密切相关,是一种常见的肺炎,临床具有合并症多、细菌耐药性高和预后较差的特点,抗生素的选择要兼顾医院感染病原菌.
目的 探討衛生保健相關性肺炎(HCAP)在我院的髮病情況及臨床特點.方法 迴顧性研究我院2007年1月-2008年4月的連續性肺炎住院患者. 結果 符閤HCAP 75例,佔本組肺炎的26.4%,對照社區穫得性肺炎(CAP)133例、醫院穫得性肺炎(HAP)76例.HCAP的髮生主要有反複住院(47例)、門診輸液(27例)、化療或抗生素應用(27例)等因素;閤併基礎疾病71例(94.7%),顯著高于CAP(37.6%,P<0.01),與HAP相似(88.2%,P >0.05);HCAP的細菌學特點:痰標本暘性率(56.9%)和細菌耐藥性與HAP相似(P>0.05);起始抗菌藥治療有效47例(62.6%),34例病原學暘性病例中,起始抗菌藥能夠覆蓋病原的18例(52.9%);HCAP死亡9例(12.0%),高于CAP(P <0.05),與HAP比較差異無統計學意義(P>0.05). 結論 HCAP的髮生與醫療環境有密切相關,是一種常見的肺炎,臨床具有閤併癥多、細菌耐藥性高和預後較差的特點,抗生素的選擇要兼顧醫院感染病原菌.
목적 탐토위생보건상관성폐염(HCAP)재아원적발병정황급림상특점.방법 회고성연구아원2007년1월-2008년4월적련속성폐염주원환자. 결과 부합HCAP 75례,점본조폐염적26.4%,대조사구획득성폐염(CAP)133례、의원획득성폐염(HAP)76례.HCAP적발생주요유반복주원(47례)、문진수액(27례)、화료혹항생소응용(27례)등인소;합병기출질병71례(94.7%),현저고우CAP(37.6%,P<0.01),여HAP상사(88.2%,P >0.05);HCAP적세균학특점:담표본양성솔(56.9%)화세균내약성여HAP상사(P>0.05);기시항균약치료유효47례(62.6%),34례병원학양성병례중,기시항균약능구복개병원적18례(52.9%);HCAP사망9례(12.0%),고우CAP(P <0.05),여HAP비교차이무통계학의의(P>0.05). 결론 HCAP적발생여의료배경유밀절상관,시일충상견적폐염,림상구유합병증다、세균내약성고화예후교차적특점,항생소적선택요겸고의원감염병원균.
Objective To study the clinical characteristics of healthcare-associated pneumonia (HCAP).Methods A retrospective cohort study was conducted on consecutive hospitalized pneumonia cases from January 2007 through April 2008.Results HCAP group of 75 patients was compared with 133 patients of community-acquired pneumonia (CAP) and 76 patients of hospital-acquired pneumonia (HAP). Most of HCAP patients had a history of recent hospitalization (47 cases), clinical IV infusion (27 cases), and prior chemotherapy or antibiotic therapy (27 cases). Underlying diseases were identified in 71 (94.7%) of HCAP patients, significantly higher than that in CAP group (37.6%, P<0.01). Positive sputum culture in CAP, HCAP and HAP was 22.6%, 56.9%, 77.6% respectively. Antibiotic resistance of bacteria in HCAP (71.43%) and HAP (80%) was comparable (P>0.05). Initial antibiotic therapy was effective in 47 (62.6%) cases of HCAP. Only 52.9% of the identified pathogens were sensitive to initial antibiotic therapies. The mortality of HCAP (12%) was similar to HAP (23%, P>0.05), but significantly higher than CAP (3%, P<0.05).Conclusions HCAP is a common type of pneumonia, which is characterized by more resistant pathogens, higher mortality, more comorbidities and poor outcomes. Antibiotic therapy should cover the hospital acquired bacterial pathogens.
