【摘要】 目的探讨卫生保健相关性肺炎(HCAP)的临床特征以及病原学特点,以指导临床治疗。方法对2009年1月至2010年12月收住常熟一院呼吸科治疗的65例HCAP患者进行回顾分析,总结其临床特征和病原学特点。结果符合HCAP65例,平均年龄68岁,病死率为23.1%,HCAP的发生主要有反复住院(4例)、长期住护理院(15例)、化疗或抗生素应用(46例)等因素。HCAP临床表现不典型,基础疾病多,以慢性肺部疾病为主,占52.3%。病原菌以革兰阴性菌最常见,占61.1%,革兰阳性菌占27.8%,真菌占11.1%。常见的病原菌为铜绿假单胞菌、肺炎克雷伯菌、金葡菌和大肠埃希菌,其中革兰氏阴性杆菌的耐药率为63.6%。结论 HCAP患者年龄大,基础疾病多,病死率高,病原菌以革兰阴性菌为主,初始抗菌药物应注意覆盖耐药菌。更多还原

【Abstract】 Objective To investigate 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 December 2010. The baseline characteristics, disease severity, pathogen distribution, antibiotic regimens and outcomes were reviewed. Results A total of 65 patients with HCAP were evaluated. The mean age was 68 years. The mortality was 23.1%. Most of HCAP patients had a history of recent hospitalization(4 cases),long-term care facility (15 cases), and prior chemotherapy or antibiotic therapy (46 cases).The symptom of HCAP patients was atypical, most of them suffered from underlying diseases especially from chronic lung diseases(52.3%).The pathogens included Gram-negative bacilli (61.1%), gram-positive cocci (27.8%) and fungus(11.1%). The frequently isolated pathogens were P. aeruginosa, K. pneumoniae, E. coli and S. aureus. Conclusion HCAP is a common type of pneumonia,which is characterized by more comorbidities, more resistant bacteria, higher mortality and poor outcomes. The major pathogen is gram-negative bacilli, so antibiotic therapy should cover the resistant gram-negative bacilli.更多还原