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目的:探讨医院获得性肺炎(HAP)的临床特点、病原学分布和药敏情况,以指导临床诊疗。方法:回顾性分析2008年1月-2012年12月收治的76例HAP患者的临床资料。结果:HAP的发生率为1.69%,所有患者均有相关基础疾病和易患高危因素,合并两种以上基础疾病者死亡率高。分离的病原菌中,革兰氏阴性菌占60.17%,革兰氏阳性菌占32.20%,真菌占6.78%,不动杆菌、铜绿假单胞菌、肺炎克雷白杆菌、金黄色葡萄球菌为主要致病菌。不动杆菌、产ESBLs的肺炎克雷白杆菌耐药率较高,但碳青霉烯类和β-内酰胺类抗生素/酶抑制剂治疗效果仍较好,所有革兰氏阳性菌对万古霉素和利奈唑胺敏感。结论:减少各种高危因素,严格进行病原学检测和药敏试验,针对病原菌情况合理应用抗生素是提高HAP疗效的关键。
Objective: To investigate the clinical characteristics, pathogenic distribution and drug susceptibility of hospital acquired pneumonia (HAP) to guide clinical diagnosis and treatment. Methods: The clinical data of 76 HAP patients admitted from January 2008 to December 2012 were retrospectively analyzed. Results: The incidence of HAP was 1.69%. All patients had underlying diseases and high risk factors. All patients with more than two underlying diseases had high mortality. Isolated pathogens, Gram-negative bacteria accounted for 60.17%, Gram-positive bacteria accounted for 32.20%, fungi accounted for 6.78%, Acinetobacter, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus as the main Pathogenic bacteria. Acinetobacter, ESBLs-producing Klebsiella pneumoniae resistant rate is higher, but carbapenems and β-lactam antibiotics / enzyme inhibitor treatment is still good, all Gram-positive bacteria against Vancomycin Susceptibility and linezolid sensitive. Conclusion: To reduce various risk factors, strict pathogen detection and drug susceptibility testing, rational use of antibiotics for pathogens is the key to improve the efficacy of HAP.