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目的了解重庆地区医院获得性肺炎(hospital acquired pneumonia,HAP)治疗转归、病原学分布及其耐药性特点,为本地区治疗HAP提供资料和依据。方法选取重庆市不同等级4家医疗机构在2009年1月至2010年12月符合HAP诊断标准的病例512例,对患者的性别、年龄、治疗转归、基础疾病、病原学及其耐药谱进行回顾性对照研究。结果 4家医疗机构的HAP患者性别不存在差异,平均年龄以重庆市第一福利院(78.6岁)最高,与其他3组存在显著性差异(P<0.05)。HAP总死亡率为23.4%。与本次住院直接相关的基础疾病分析显示脑卒中及其后遗症是导致HAP最常见的原因(24.4%),其次是呼吸衰竭(包括急性和慢性)(17.2%),其他依次为心血管病(8.3%)、肿瘤(7.7%)、手术后(7.1%)、慢性阻塞性肺疾病(6.9%)、尘肺(5.9%)、糖尿病(4.4%)、老年痴呆(3.8%)、营养不良(2.4%)。HAP病原菌以G-菌为主,占73.2%,以铜绿假单胞菌(27.2%)最常见;G+菌占22.9%,以金黄色葡萄球菌(13.0%)最常见;真菌占3.9%,均为混合感染。在福利院发生的HAP病原菌以肺炎链球菌、流感嗜血杆菌、金黄色葡萄球菌、大肠埃希菌和表皮葡萄球菌为主。结论重庆地区HAP死亡率较高,脑卒中及其后遗症是导致HAP最常见的原因。在福利院与在其他医疗单位发生的HAP病原谱不同。HAP病原菌以铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌为主,耐药情况严重。
Objective To investigate the outcome of hospital acquired pneumonia (HAP) treatment in Chongqing and its etiological distribution and drug resistance, and to provide information and evidence for the treatment of HAP in this area. Methods 512 cases of HAP diagnostic criteria from 4 hospitals of different grades in Chongqing from January 2009 to December 2010 were selected and their gender, age, treatment outcome, underlying diseases, etiology and their drug resistance spectrum A retrospective, controlled study was performed. Results There was no difference in gender among HAP patients in the four medical institutions. The average age was the highest in Chongqing First Welfare Institute (78.6 years old) and significant difference (P <0.05) compared with the other three groups. The overall HAP mortality rate was 23.4%. Analysis of underlying diseases directly related to this hospitalization showed that stroke and its sequelae were the most common causes of HAP (24.4%), followed by respiratory failure (17.2%), followed by cardiovascular disease 8.3%), tumor (7.7%), postoperation (7.1%), chronic obstructive pulmonary disease (6.9%), pneumoconiosis (5.9%), diabetes mellitus (4.4%), dementia (3.8%), malnutrition %). The majority of HAP pathogens were G-bacteria, accounting for 73.2% of the total, Pseudomonas aeruginosa (27.2%) being the most common, G + bacteria accounting for 22.9%, Staphylococcus aureus (13.0%) being the most common, and fungi accounting for 3.9% For mixed infection. HAP pathogens that occur in welfare homes are mainly Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Escherichia coli and Staphylococcus epidermidis. Conclusion HAP mortality in Chongqing is high. Stroke and its sequelae are the most common causes of HAP. In welfare homes and in other medical units occur HAP pathogenic spectrum is different. HAP pathogens to Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus-based resistance was serious.