摘要
目的分析呼吸重症加强治疗病房(RICU)晚发性医院获得性肺炎(L-HAP)的病原学分布特征及危险因素。方法采用回顾性病例对照研究,收集2003年3月至2008年3月复旦大学附属中山医院RICU住院的L-HAP患者30例,同期RICU住院期间未发生HAP的患者30例作为对照,进行单因素和多因素Logistic回归分析。根据L-HAP患者发病时间(入院第6～14d,第15～28d,第29d后)进行分层,进一步分析L-HAP的病原学分布特征。结果 L-HAP组与对照组在意识不清、误吸、有创机械通气、低白蛋白血症及质子泵抑制剂使用时间方面差异有统计学意义(P<0.05)。Logistic多因素分析显示机械通气(OR=8.7)、低白蛋白血症(OR=20.4)是RICU内发生L-HAP的独立危险因素(P<0.05)。L-HAP组患者住院时间、抗生素使用时间均较对照组显著延长,病死率亦明显升高(P<0.05)。入院第6～14d发病的L-HAP需氧病原菌主要为鲍曼不动杆菌、肺炎克雷伯菌,住院第15～28d为铜绿假单胞菌、鲍曼不动杆菌及金黄色葡萄球菌,住院29d后主要为铜绿假单胞菌、嗜麦芽窄食单胞菌。结论机械通气、低白蛋白血症是RICU内发生L-HAP的独立危险因素。发生L-HAP显著增加患者病死率、增加住院天数及增加抗生素的使用。住院不同阶段L-HAP的病原谱发生改变。
Objective To analyze the etiology,risk factors,and prognosis of late-onset hospital-acquired pneumonia （L-HAP） in respiratory ICU.Methods In this retrospective case control study,30 L-HAP patients and 30 patients without HAP in respiratory ICU were enrolled to investigate the features and risk factors of L-HAP.Stratification was made according to the onset time of L-HAP.The etiology and pathogen distribution at each stage were described and analyzed.Results Univariate analysis revealed that unconsciousness,aspiration,mechanical ventilation,hypoalbuminemia,and long-term use of proton pump inhibitor were significantly associated with L-HAP.Logistic regression analysis revealed that mechanical ventilation（OR=8.7） and hypoalbuminemia （OR=20.4） were independent risk factors for L-HAP.The L-HAP patients had longer stay in hospital,long-term antibiotic use,and higher mortality compared with the patients without HAP.For the patients whose L-HAP onset time within 6-14 days,the dominated pathogens were Acinetobacter baumannii and Klebsiella pneumonia.For those within 15-28 days,the dominated pathogens were Pseudomonas aeruginosa,Acinetobacter baumanni,and Staphylococcus aureus.For those beyond 29 days,the dominated pathogens were Pseudomonas aeruginosa and Stenotrophomonas maltophilia.Conclusions Mechanical ventilation and hypoalbuminemia are independent risk factors for L-HAP.The pathogen features of L-HAP are quite different at different inhospital stage.
出处
《中国呼吸与危重监护杂志》
CAS
2010年第4期386-390,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
上海市公共卫生优秀青年人才培养计划(编号:08GWQ028)
