摘要
目的探讨发生医院获得性肺炎(HAP)患者的病原菌分布和耐药率情况以及血清钠水平和C-反应蛋白指标的变化,为临床预防治疗提供研究依据。方法选取2012年4月-2016年10月2470例住院患者为研究对象,将发生肺炎情况进行统计,并对病原菌进行分离鉴定,以药敏试验分析其耐药情况,同时检测患者的血清钠水平和C-反应蛋白指标的变化。结果 2470例住院患者中有132例为HAP,感染率为5.34%;132例HAP患者共检出病原菌258株,其中革兰阴性菌134株占51.94%、革兰阳性菌106株占41.08%、真菌18株占6.98%,药敏试验显示:铜绿假单胞菌和鲍氏不动杆菌对亚胺培南、头孢哌酮/他巴唑和哌拉西林的耐药率较低,对头孢曲松和庆大霉素耐药率较高;革兰阳性菌以耐甲氧西林的金葡菌42株占16.28%和凝固酶阴性葡萄球菌28株占10.85%居多,对万古霉素、替考拉宁的耐药率较低,对氨苄西林和青霉素的耐药率较高;HAP患者的血清钠水平(110.16±8.76)mmol/L和C-反应蛋白(143.49±26.07)mg/L指标较其他非感染肺炎患者明显降低和升高,差异有统计学意义(P<0.05)。结论医院获得性肺炎患者的主要致病菌为革兰阴性菌,患者的血清钠水平降低和C-反应蛋白升高明显,经过药敏试验明确感染菌的耐药情况,为临床治疗中选择敏感度高的抗菌药物提供科学依据。
OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from the patients with hospital-acquired pneumonia（HAP）and observe the levels of serum sodium and C-reactive protein so as to provide guidance for clinical prevention and treatment.METHODS A total of 2470 patients who were hospitalized from Apr2012 to Oct 2016 were recruited as the study objects,the incidence of pneumonia was statistically analyzed,the pathogens were isolated and identified,the drug susceptibility testing was carried out,and the levels of serum sodium and C-reactive protein were detected.RESULTS The infection rate was 5.34%（132cases）among the 2470 hospitalized patients.Totally 258 strains of pathogens were isolated from the 132 patients with HAP,of which134（51.94%）were gram-negative bacteria,106（41.08%）were gram-positive bacteria,and 18（6.98%）were fungi.The drug susceptibility testing showed that the drug resistance rates of Pseudomonas aeruginosaand Acinetobacter baumannii to imipenem,cefoperazone-tazobactam,and piperacillin were relatively low,while the drug resistance rates to ceftriaxone and gentamicin were relatively high.The methicillin-resistant Staphylococcus aureus（42strains,16.28%）and coagulase-negative Staphylococcus（28strains,10.85%）were dominant among the gram-positive bacteria,the drug resistance rates of the strains to vancomycin and teicoplanin were relatively low,while the drug resistance rates to ampicillin and penicillin were relatively high.The levels of serum sodium and Creactive protein of the HAP patients were respectively（110.16±8.76）mmol/L and（143.49±26.07）mg/L,significantly higher and lower than those of the non-pneumonia patients,and there was significant difference（P〈0.05）.CONCLUSIONS The gram-negative bacteria are dominant among the pathogens isolated form the patient with HAP,the serum sodium level is reduced,and the C-reactive protein level is significantly elevated.It is necessary to conduct the drug susceptibility testing for the pathogens causing the infection so as to provide scientific basis for clinical treatment with sensitive antibiotics.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第13期2976-2979,共4页
Chinese Journal of Nosocomiology
关键词
医院获得性肺炎
病原菌分布
耐药率
血清钠水平
C-反应蛋白
Hospital-acquired pneumonia
Distribution of pathogen
Drug resistance rate
Serum sodium level
Creactive protein
