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目的探讨神经内科住院患者不同时间发生的医院内获得性肺炎(HAP)的危险因素、病原体构成及抗菌药物敏感性的时间差异。方法在同济医院神经内科回顾调查2004年1月~2006年5月间痰培养致病菌阳性HAP病例,记录患者性别、年龄、病种、相关因素及致病菌药敏试验结果,并比较早、中、晚发HAP的相关因素、病原体构成及其抗菌药物敏感性的差异。结果共有93例患者入选,入院时间≤5d发病者(早发)23例,6~14d发病者(中发)54例,≥15d发病者(晚发)16例;不同时间发生的HAP的高危因素有所差异,以昏迷和气管切开为主要高危因素;分离出致病菌225株,其中铜绿假单胞菌(53株)、金黄色葡萄球菌(33株)、耐甲氧西林的金黄色葡萄球菌(MRSA)(27株)、鲍曼氏不动杆菌(25株)、阴沟肠杆菌(21株)和嗜麦芽窄食单胞菌(18株)为最多见的前6位致病菌;统计学分析显示不同发病时间的HAP中铜绿假单胞、肺炎克雷伯菌、嗜麦芽窄食单胞菌构成比有统计学意义(P<0.05),即早发性HAP以嗜麦芽窄食单胞菌最常见(20.0%),阴沟肠杆菌(13.3%)占有一定比例,而晚发性HAP以铜绿假单胞菌(43.7%)和耐甲氧西林的金黄色葡萄球菌(MRSA)(9.86%)为主;HAP病原体药物敏感性受发病时间影响明显,在早发敏感性较高,而晚期重症HAP病原菌的敏感性低。结论同济医院神经内科不同发病时间HAP的病原体构成具有明显差别,早发病例中药物敏感菌多见。
Objective To investigate the risk factors of hospital acquired pneumonia (HAP), the composition of pathogens and the time difference of antimicrobial sensitivity in hospitalized patients with neurology at different times. Methods A retrospective investigation was carried out in neurology of Tongji Hospital between January 2004 and May 2006 for the positive cases of HAP caused by sputum culture. The gender, age, disease type, related factors and susceptibility test results of pathogens were recorded and compared earlier , Middle and late HAP related factors, the composition of pathogens and their differences in antimicrobial susceptibility. Results A total of 93 patients were enrolled in this study. Twenty-three patients were admitted to the hospital on the 5th day of admission, 54 were diagnosed at 6 to 14 days (onset), 16 were diagnosed as ≥15 days (late onset), and those with HAP at different times Among them, 225 strains of pathogens were isolated, of which Pseudomonas aeruginosa (53 strains), Staphylococcus aureus (33 strains), methicillin-resistant gold Staphylococcus aureus (MRSA) (27 strains), Acinetobacter baumannii (25 strains), Enterobacter cloacae (21 strains) and Stenotrophomonas maltophilia (18 strains) were the most common first 6 pathogens Staphylococcus aureus, Klebsiella pneumoniae and Stenotrophomonas maltophilia in HAP at different stages of onset were statistically significant (P <0.05), that is, the incidence of early onset HAP in malt Stenotrophomonas most commonly (20.0%), Enterobacter cloacae (13.3%) accounted for a certain proportion, and late-onset HAP Pseudomonas aeruginosa (43.7%) and methicillin-resistant Staphylococcus aureus (MRSA ) (9.86%). The drug susceptibility of HAP pathogens was significantly affected by the onset time, with a higher sensitivity in early onset and lower sensitivity to severe HAP pathogens in late stage. Conclusions The pathogens of HAP at different stages of neurology in Tongji Hospital have obvious differences. The drug-susceptible strains in early onset cases are more common.