Characteristics Of Etiology In Healthcare-associated Pneumonia Among Adults In Emergency Department

Objective:To analyze the results of the pathogens distribution and antibiogram in patients with healthcare-associated pneumonia(HCAP)in emergency department,to provide the basis for rational use of antibiotics in the region.Methods:4138 patients with HCAP were conducted who were hospitalized between November 2014 and April2017,in emergency department of the First Affiliated Hospital of Xinjiang Medical University in China,based on the inclusion and exclusion criteria,783 patients were enrolled finally whose specimens were obtained within 48 hours after admission and pathogens were detected in the follow up.The age,sex,underlying diseases,vital signs,sputum culture and drug sensitivity test of HCAP patients were recorded and analyzed statistically.Divided them into 2 groups according to the age:younger group(<65 years)and the elder group(≥65 years),compared with the differences in pathogens of 2 groups.All statistical analyses were performed using SPSS 19.0,α=0.05,using the Chi-square test or Fishers exact test for categorical data,using the Student t test for normally distributed variables and the Mann-Whitney U test for non-normally distributed variables.Result:Of 783 enrolled patients,the average age was(62±17.5)years old(range 18 to 98),there were 532(67.9%)males and 251(32.1%)females,patients were classified into the younger group(364 cases,46.5%)and the elder group(419cases,53.5%),younger group were significantly more likely to have central nervous system disorders,hematologic deisease,rheumatologic disease and peripheral vascular disease than elder group(P<0.05),Whereas elder group were significantly more likely to have cardiovascular disease,chronic lung disease,solid organ malignancy,diabetes mellitus,hypertension and two or more comorbidities than younger group(P<0.05).There is no significant difference in pathogens distribution or antibiogram.The isolation rate of extended-spectrumβ-lactamases(ESBL)(10.4%and 13.1%)and methicillin resistant staphylococcus aureus(MRSA)(3.6%and 6.2%)were low,no significant difference between the two groups(P>0.05),although the difference of MSSA was statistically significant(χ~2=4.577,P=0.032).Most of the pathogens were Gram-negative(670 cases,85.6%),according to the proportion of pathogens,the top 5 bacteria in sequence were:Acinetobacter baumannii(214 cases,27.3%),Klebsiella pneumoniae(182cases,23.2%),Pseudomonas aeruginosa(83 cases,10.6%),Staphylococcus aureus(66cases,8.4%),Escherichia coli(58 cases,7.4%).The drug resistance of Acinetobacter baumannii is the most critical,followed by Pseudomonas aeruginosa and MRSA.The pathgens were generally drug-resistant to the first and second generation cephalosporin,besides they were sensitive to carbapenem,sulfamethoxazole and trimethoprim,polymyxin B,no bacteria was drug-resistant to vancomycin or quinupristin/dalfopristin.Furthermore,Streptococcus pneumoniae was resistant to erythromycin(93.8%),the drug resistance rate of Escherichia coli,Klebsiella pneumoniae to the third generation cephalosporin were 62.1%,26.4%,the drug resistance rate of Escherichia coli,Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter Baumannii to carbapenem were 1.7%,1.1%,30.1%,71.5%.Conclusion:HCAP had a large proportion in the adult pnuemonia in the emergency department.The majority of the patients were elder males,Age has little influence on the etiology of HCAP,and the distribution and drug resistance of HCAP pathogens in this region had their own regional characteristics,which provided a theoretical basis for rational use of antibiotics for clinicians.