成人社区及医院获得性肺炎病原菌及耐药性差异

 目的 比较非呼吸机相关医院获得性肺炎（NV-HAP）、呼吸机相关肺炎（VAP）与社区获得性肺炎（CAP）感染病原菌分布及耐药性。方法 回顾性调查2017年10月-2019年9月某院肺炎患者病历资料，按NV-HAP、VAP、CAP定义将患者分别列为NV-HAP组、VAP组、CAP组。收集三组患者痰、支气管肺泡灌洗液、血标本培养病原菌及药敏试验结果，分析三组患者感染病原菌构成和耐药性差异。结果 共纳入肺炎患者4 391例，NV-HAP组1 080例，VAP组126例，CAP组3 185例，各组分别检出病原菌841、191、1 440株，均以革兰阴性（G^-）菌为主，依次占72.77%、84.82%和61.18%，三组患者检出病原菌分布比较，差异有统计学意义（χ²=64.037，P<0.001）。鲍曼不动杆菌对头孢吡肟、头孢哌酮/舒巴坦、亚胺培南、庆大霉素、妥布霉素、左氧氟沙星、环丙沙星和复方磺胺甲口恶唑耐药率，铜绿假单胞菌对头孢哌酮/舒巴坦和亚胺培南耐药率，肺炎克雷伯菌对常用抗菌药物耐药率，三组比较差异均有统计学意义（均P<0.05）；金黄色葡萄球菌对红霉素、克林霉素和环丙沙星的耐药率比较，CAP组高于NV-HAP组（P<0.05）。结论 NV-HAP、VAP和CAP在病原菌分布及细菌耐药性方面均存在差异，在制定临床治疗方案时，要区别对待不同感染类型的肺炎。

Difference in pathogens and antimicrobial resistance in community-acquired and hospital-acquired pneumonia in adults

Objective To compare the distribution and antimicrobial resistance of pathogens in non-ventilator hospital-acquired pneumonia (NV-HAP), ventilator-associated pneumonia (VAP) and community-acquired pneumonia (CAP). Methods Medical records of patients with pneumonia in a hospital from October 2017 to September 2019 were retrospectively investigated, according to the definition of NV-HAP, VAP and CAP, patients were divided into NV-HAP group, VAP group and CAP group. Sputum, bronchoalveolar lavage fluid and blood specimens were collected from three groups, difference in constituent and antimicrobial resistance of pathogens of three groups were analyzed. Results A total of 4 391 patients with pneumonia were included, including 1 080 cases in NV-HAP group, 126 in VAP group and 3 185 in CAP group, 841, 191 and 1 440 strains of pathogens were isolated from each group, mostly were Gram-negative bacteria, accounted for 72.77%, 84.82% and 61.18% respectively, difference in distribution of pathogens isolated from three groups was statistically significant (χ²=64.037, P<0.001). Antimicrobial resistance rates of Acinetobacter baumannii to cefepime, cefoperazone/sulbactam, imipenem, gentamicin, tobramycin, levofloxacin, ciprofloxacin and compound sulfamethoxazole, resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam and imipenem, as well as resistance rates of Klebsiella pneumoniae to commonly used antimicrobial agents among three groups were all statistically significant (all P<0.05); resistance rates of Staphylococcus aureus to erythromycin, clindamycin and ciprofloxacin in CAP group were all higher than in NV-HAP group (P<0.05). Conclusion NV-HAP, VAP and CAP are different in pathogenic distribution and antimicrobial resis-tance, in the formulation of clinical treatment program, different types of pneumonia should be treated differently.