50例重症院内获得性肺炎的诊治分析

目的:观察重症院内获得性肺炎患者的细菌耐药情况和预后.方法:对50例重症HAP患者进行前瞻性观察研究,分析患者一般情况、初始痰培养和药物敏感性、机械通气时间以及病死率.结果:初始细菌培养阳性菌株53株,其中革兰阴性菌39株(73.6％),以铜绿假单胞菌(28.3％)、鲍曼不动杆菌(18.9％)、肺炎克雷伯杆菌(11.3％)为多见；革兰阳性菌14株(26.4％),均为耐甲氧西林金黄色葡萄球菌(MRSA).细菌耐药情况严重.所有患者30 d粗病死率为16％(8/50).在43例初始细菌培养阳性患者中,恰当初始抗生素应用率为63.8％ (27/43)；治疗组恰当与不恰当组的机械通气时间分别为8.9±5.2d和15.4±10.1d,有显著性差异(P＜0.05)；2组30d粗病死率分别为11.1％和25.0％,无显著性差异(P＞0.05).结论:重症院内获得性肺炎的致病菌耐药率高,恰当初始抗生素治疗可以降低机械通气时间.应加强细菌耐药监测及合理应用抗生素.

Analysis of the diagnosis and treatment of 50 cases with severe hospital-acquired pneumonia

Objective:To observe the drug resistance to antimicrobics in treating patients with severe hospital-acquired pneumonia (HAP) and its prognosis.Methods:Fifty cases with severe HAP were included in the prospective study.Initial sputum bacterial culture,bacterial sensitivity,days of mechanical ventilation and mortality were analyzed.Results:Totally 53 strains of pathogens were isolated by initial bacterial culture.The G-bacteria was 39 (73.6%) among which pseudomonas aeruginosa (28.3%),Acinetobacter baumannii (18.9%) and Klebsiella pneumoniae (11.3%) were commonly seen.G+ bacteria was 26.4% in which all were methicillin-resistant staphylococcus aureus (MRSA).The condition of drug resistance was serious.The overall crude 30-day mortality rate was 16%(8/50).Of 43 cases whose initial bacterial culturing were positive,27 patients received appropriate initial antimicrobial therapy(AIAT,63.8%).Days of mechanical ventilation in AIAT group and non-AIAP group were 8.9±5.2 and 15.4±10.1d respectively (P<0.05).There was no significant difference in the crude 30-day mortality between the two groups(11.1% vs 25.0%,P>0.05).Conclusions:Antimicrobial resistance was serious in severe HAP.AIAT can reduce days of mechanical ventilation.It is suggested that an urgent surveillance of bacterial resistance and rational use of antimicrobial agents should be strengthened.