非免疫抑制患者医院获得性肺炎及呼吸机相关肺炎病原菌组成及耐药性分析

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人院后（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72h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〉32mg／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=128mg／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。

Pathogens composition and antibiotic resistance of non-immunocompromised patients with hospital acquired pneumonia and ventilator-associated pneumonia

Objective To investigate the clinical features,pathogens composition,antibiotic resistance of non-immunocompromised patients with hospital acquired pneumonia(HAP) or ventilator-associated pneumonia(VAP) in order to guide clinical antibiotics use.Method 46 non-immunocompromised patients with HAP or VAP diagnosed by a prospective surveillance were retrospectively reviewed.Result The average onset duration was 14.3±13.2 days after admission and the most common underlying diseases were cerebrovascular disease(16/46),chronic lung disease(13/46) and diabetes mellitus(5/46).The positive culture rate was 58.7%,with Acinetobacter baumannii(8/27),Pseudomonas aeruginosa(6/27),Enterobacter cloacae(3/27) and Staphylococcus aureus(3/27) being leading pathogens.80.4% of patients had been priscribed antibiotics within 72 hours after admission.Cephalosporins(29/46),Carbapenems(9/46) and Glycopeptides(5/46) were the most commonly used antibiotics as initial treatment.A.baumannii were intermediate to cefoperazone/sulbatam with MIC>32 mg/L and resistant to all other drugs.2 isolates of P.aeruginosa were highly resistant to meropenem with MIC=128 mg/L.Conclusion HAP or VAP of non-immunocompromised patients is prone to occur in gerontal patients with cerebrovascular diseases or chronic lung diseases.The leading pathogens of HAP are multidrug-resistant A.baumannii and P.aeruginosa with high antibiotics resistance to carbapenem.We shall optimize the initial antibiotics use in HAP/VAP treatment.