摘要
目的探讨卫生保健相关性肺炎(HCAP)在青岛市市立医院的发病情况,了解其临床特征及病原学特点以指导临床治疗。方法按照CURB-65评分系统将2009年1月—2010年5月住院治疗的91例HCAP患者分为轻症组84例和重症组7例,回顾性分析总结两组的临床特征及病原学特点。结果重症HCAP患者的平均年龄显著高于轻症组[(83.9±7.1)和(65.1±17.8)岁,P<0.001],其基础疾病合并症显著多于轻症组(100%和76.2%),其临床症状(如发热、咳嗽、气短、意识障碍)的比率显著高于轻症组(P<0.05),相关实验室指标(如白细胞异常、尿素氮升高、低氧血症或低氧和指数)明显重于轻症组(P<0.01)。与轻症组相比,重症HCAP患者多次住院、接受家庭或医疗机构护理者更多(P<0.001)。重症HCAP患者多种细菌混合感染高达71.4%,其中革兰阴性菌占44.5%,革兰阳性菌占22.2%,念珠菌占33.3%,初始抗生素治疗未能覆盖病原菌而治疗不当者4例,死亡3例,与轻症组相比差异均有统计学意义(P<0.01)。结论 HCAP的发生与医疗环境密切相关,其中CURB-65评分高的重症患者基础疾病多,病原菌中多重耐药菌发生率高,预后差。必须充分认识HCAP发病的危险因素和病情严重程度,建立个体化"经验性治疗方案",以改善预后。
Objective To study the clinical characteristics and pathogens in patients with healthcare-associated pneumonia （HCAP）. Methods A retrospective observational study was conducted on HCAP patients who were hospitalized from January 2009 to May 2010. The patients were divided into mild or severe group based on CURB-65 scores. The baseline characteristics, pathogen distribution, antibiotic regimens and outcomes were analyzed. Results The patients with severe HCAP were significantly older （mean age 83.9 ±7. 1 versus 65. 1±17.8 years old, P〈0. 001）, with more underlying diseases （100% versus 76.2%）, more clinical symptoms （e. g. fever, cough, dyspnea and alteration in consciousness） （P〈0.05）, and more severe laboratory abnormalities （e. g. , WBC count, blood urea nitrogen, hypoxemia or low Pao2/Fio2 ） compared with the patients with mild HCAP. The severe HCAP patients more likely had a history of recent stay in hospital （42.6%） or long-term care fa- cility （71.4%） （P〈0. 001 ）. Mixed infection was identified in 71.4% of the patients with severe HCAP. The pathogens included gram-negative bacillus （44.5 % ）, gram-positive bacteria （22.2 %） and Candida （33.3 %）. The initial antibiotic therapy was inappropriate in 4 cases due to poor coverage, and led to 3 deaths. This was significantly different from the patients with mild HCAP （P〈 0.01 ）. Conclusions The occurrence of HCAP is closely related to healthcare environment. It is characteristic of more underlying diseases, more multidrug-resistant bacteria, and poor outcome, especially prevalent in patients with high CURB-65 score. Evaluation of the risk factors and severity of HCAP is essential for developing an individualized ＂best empirical regimen＂.
出处
《中国感染与化疗杂志》
CAS
2011年第6期452-456,共5页
Chinese Journal of Infection and Chemotherapy
