摘要
目的：探讨老年医院获得性肺炎（HAP）患者感染病原菌特点及影响预后的危险因素，为临床治疗老年医院获得性肺炎提供参考依据。方法回顾性分析2011年6月－2014年12月医院收治的120例老年 HAP患者临床资料，分析其病原菌分布、主要病原菌耐药性及影响预后的相关危险因素。结果120例老年 HAP患者共检出病原菌142株，革兰阴性菌、革兰阳性菌、真菌各91、41、10株，分别占64．09％、28．87％、7．04％；大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、铜绿假单胞菌对亚胺培南敏感性较高，金黄色葡萄球菌、肺炎链球菌、表皮葡萄球菌对万古霉素敏感性较高；logistic回归分析发现，老年HAP患者年龄≥75岁、吸烟、饮酒（持续1年以上饮酒量≥50 ml／d）、受累肺叶数较多、HAP后接受机械通气、APACHEⅡ评分高、合并基础疾病等因素是影响其预后的独立危险因素（P＜0．05）。结论老年医院获得性肺炎感染病原菌较广，且影响预后的危险因素较多，需采取相应措施，控制感染，提高患者的预后。
Abstract
OBJECTIVE To observe the characteristics of pathogens causing infections in elderly patients with hospi‐tal‐acquired pneumonia (HAP) and explore the influencing factors for prognosis so as to provide guidance for clini‐cal treatment of the elderly patients with HAP .METHODS The clinical data of 120 elderly patients with HAP who were treated in the hospital from Jun 2011 to Dec 2014 were retrospectively analyzed .The distribution of patho‐gens ,drug resistance of main pathogens ,and influencing factors for prognosis were observed .RESULTS A total of 142 strains of pathogens were isolated from the 120 elderly patients with HAP ,including 91 (64 .09% ) strains of gram‐negative bacteria ,41 (28 .87% ) strains of gram‐positive bacteria ,and 10 (7 .04% ) strains of fungi .The Escherichiacoli ,Klebsiella pneumoniae ,Acinetobacter baumannii ,and Pseudomonas aeruginosa were highly susceptible to imipenem ;the Staphylococcus aureus ,Streptococcus pneumoniae ,and Staphylococcus epidermidis were highly susceptible to vancomycin .The logistic regression analysis showed that the independent risk factors for the prognosis of the elderly patients with HAP included the no less than 75 years of age ,smoking ,drinking (alcohol consumption no less than 50ml /d for more than one year ) ,large number of lobes involved ,receiving mechanical ventilation after HAP ,high APACHEⅡ score ,and complication of underlying diseases (P<0 .05) . CONCLUSION The elderly patients with HAP have broad spectrum of pathogens ,and there are a variety of influ‐encing factors for the prognosis .It is necessary to take targeted measures of control of the infections so as to im‐prove the prognosis of the patients .
NETL
NSTL
维普
万方数据