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目的分析非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎临床特征、病原菌组成及耐药性,指导临床诊断及合理使用抗菌素。方法回顾性分析46例前瞻性观察诊断的非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎临床及微生物学资料。结果平均起病时间为入院后(14.3±13.2)d,最常见基础疾病依次为脑血管意外(16/46),慢性肺部疾病(13/46)和糖尿病(5/46)。培养阳性率58.7%,最常见细菌依次为鲍曼不动杆菌(8/27)、铜绿假单胞菌(6/27)、阴沟肠杆菌(3/29)及金黄色葡萄球菌(3/29)。80.4%患者入院72 h内使用过抗生素,初始经验性治疗最常使用的抗菌素依次为头孢菌素(29/46)、碳青霉烯类(9/46)、糖肽类(5/46)。8株鲍曼不动杆菌对头孢哌酮/舒巴坦中介MIC>32 mg/L,对其他抗生素耐药;2株铜绿假单胞菌对美罗培南高度耐药MIC=128 mg/L。结论非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎多发生在有脑血管疾病及慢性肺疾病老年患者,我院非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎最常见的病原菌多药耐药鲍曼不动杆菌,铜绿假单胞菌对碳青霉烯类耐药率较高。应优化医院获得性肺炎及呼吸机相关肺炎初始抗生素使用。
Objective To analyze the clinical characteristics, pathogen composition and drug resistance of hospital-acquired pneumonia and ventilator-associated pneumonia in non-immunosuppressed patients, to guide clinical diagnosis and rational use of antibiotics. Methods Retrospective analysis of 46 cases of non-immunosuppressive patients with prospective observational diagnosis of hospital-acquired pneumonia and ventilator-associated pneumonia clinical and microbiological data. Results The average onset time was 14.3 ± 13.2 days after admission. The most common underlying diseases were cerebrovascular accident (16/46), chronic lung disease (13/46) and diabetes (5/46). The positive rate was 58.7%. The most common bacteria were Acinetobacter baumannii (8/27), Pseudomonas aeruginosa (6/27), Enterobacter cloacae (3/29) and Staphylococcus aureus (3/29 ). Antibiotics were used in 80.4% of the patients within 72 h after admission. The most commonly used antibiotics in the initial empirical therapy were cephalosporins (29/46), carbapenems (9/46), glycopeptides (5/46) . 8 strains of Acinetobacter baumannii cefoperazone / sulbactam mediation MIC> 32 mg / L, resistant to other antibiotics; two strains of Pseudomonas aeruginosa highly resistant to meropenem MIC = 128 mg / L. Conclusion Non-immunosuppressive patients with hospital-acquired pneumonia and ventilator-associated pneumonia mostly occur in elderly patients with cerebrovascular disease and chronic lung disease. The most common pathogens in hospital-acquired pneumonia and ventilator-associated pneumonia in non-immunosuppressive patients in our hospital are multi-drug resistant Acinetobacter baumannii, Pseudomonas aeruginosa higher resistance to carbapenems. Hospital-acquired pneumonia and initial antibiotic use in ventilator-associated pneumonia should be optimized.