不同类型老年吸入性肺炎的病原学、抗生素应用及临床转归

目的 比较老年社区获得性吸入性肺炎(CAP)、医疗相关性吸入性肺炎(HCAP)及医院获得性吸入性肺炎(HAP,包括呼吸机相关性吸入性肺炎)三者病原学、抗生素应用及治疗转归的关系.方法 收集2005年1月一2010年12月北京二炮总医院呼吸科住院的216例老年吸人性肺炎患者病例,分析其病原学结果、抗生素应用的及治疗转归.结果 三种吸入性肺炎的病原学有显著差异,与CAP和HCAP相比,HAP患者G-杆菌的感染比例明显增多(P<0.001);抗生素应用方案有明显差异,CAP组病人未调整抗生素应用比率明显高于HCAP组与HAP组(P<0.001);抗生素应用策略不同,所致死亡率有明显差异,以升阶梯方案为最高,以降阶梯治疗为最低(P=0.03).结论 三种吸入性肺炎在感染病原菌种类、抗生素应用策略及治疗转归上有明显差异,应根据不同类型的老年吸入性肺炎特点合理经验性使用抗菌药物.

The etiology, antibiotics applications and prognosis of different types of aspiration pneumonia in the elderly

Objective To assess the etiology,antibiotics applications and prognosis of community-acquired pneumonia(CAP),health-care-associated pneumonia(HCAP),and hospital-acquired pneumonia(HAP)(including ventilator-associated pneumonia VAP)in the elderly.Methods 216 elderly patients suffered from aspiration pneumonia in the pulmonary department of Beijing 2nd Artillery General Hospital from the year Jan.,2005 to Dec,2010 were admitted to our study.Results The etiology of the three various types of aspiration pneumonia was significantly different.Compared with CAP and HCAP,G-bacillus infection rate was much higher in HAP patients(P<0.001).The antibiotics applications were also significantly different in CAP,HCAP,HAP patients.More HAP and HCAP patients suffered antibiotics adjustment than CAP patients(P<0.001),The mortality varies due to different antibiotics treatment methods.De-escalation therapy significantly reduced the mortality rate of CAP,HCAP,HAP patients(P=0.03).Conclusions CAP,HCAP and HAP in the elderly was remarkable difference in etiology,antibiotics applications and prognosis.Therefore,it is essential to distinguish these three types of aspiration pneumonia in the elderly for rational use of antibiotic in the future.