Retrospective Investigation Of Hospital Acquired Pneumonia In 2～(nd) Hospital Of TMU

Objectives:To investigate the charactistics, etiology, the etiological bacteriaresistance medication prognosis of HAP in our hospital, impact of durationof hospitalization on etiology, the influence of prior antimicrobialexposure to etiological bacteria resistance.Methods:All data was take from the hospitalized cases with HAP from Jan 2004to Dec 2006, identify Record relevant clinical data, including age,gender, underlying disease, clinical diagnosis, clinical manifestationauxiliary examination, duration of hospitalization, prior exposure toantimicrobials or glucocorticoid, immunodeficiency, operation artificialairway or mechanical ventilation. Collect respiratory tract secretion toculture and analysis the susceptibility of antimicrobials, identify theetiology and resistance of HAP in our hospital. T test or x~2 test wasused to analysis the patients' characters between early-onset andlate-onset HAP, impact of onset time, prior antibiotics exposure andseverity of HAP to drug resistant bacteriaResults:During the 3 years there were 454 cases suffering from HAP, it occurredat a rate of 1.09％. incidence rate in 2004 was 1.08％, incidence rate in2005 was 1.27％, incidence rate in 2005 was 0.94.％. Among these patients,284 cases were males, age ranged from 15to 94 years, at a average age of(69.74±12.50) years. There were 70 cases of early-onset HAP. 55 strains of bacteria were isolated from respiratory tract secretion culture.394 cases of late-onset HAP, 240 strains of bacteria were isolated fromrespiratory tract secretion culture, including 22 cases of ventilatorassociated pneumoma and 109 cases of severe HAP. 388 cases usedantibiotics prior occur HAP(83.62％). The rate of prior antibiotics useincreased in late-onset HAP group were 85.78％, 92.39％in severe HAP group.295 strains of bacteria were isolated from respiratory tract secretionculture, The positive rate was 82.40％. In the 295 strains of etiologicagents, there were 95 strains of G+cocci, 160 strains of G bacterium and40 strains of fungus.The most common pathogens associated with HAP were Acinetobacterspp (15.93％), Klebsiella peumonia(12.20％), eudomonasaeruginosa(10.85％),Staphyloccus aureus(8.14％), canidia Albicans (6.78％), Enterobacter(6.10％), andStaphylococcus epidermidis(5.76％). Early-onset HAP were commonly saused byG+ cocci such as MSSA, While the main agents of late-onset HAP were G-bacilli(56.67％), including Acinetobacter baumanii, Klebsiella pneumoniaPseudomonas aeruginosa, and Enterococcus Staphylcoccus aureus.Patients admitted for respiratory diseases, there were 76 strains ofG~- bacterium, 1 strains of G+cocci, and 4 strains of fungus; Patientsadmitted for non-respiratory diseases, there were 84 strains of G~-bacterium, 94 strains of G+cocci, and 36 strains of fungus (P＜0.05).A rata1 of 116 strains of drug resistant bacteria were isolated duringthis study period including MRSA 11 strains, , MRSCoN 16 strains,multidrug resistant Pseudomonas aeruginosa 20 strains, Acinetobacterbaumanii 23 strains, Stenotrophomonas Maltophilia 4 strains, Escherichia coli with ESBLs 15 strains, Klebsiella pneumonia with ESBLs 18 strains.The resistant stains isolated rate was 14.55％in Early-onset HAP, whilethat of late-onset HAP was 45.0％(P＜0.05).midis(5.76％). Early-onset HAP were commonly saused by G+ Compared withnot using antimicrobials, prior Antimicrobials exposure increases theresistant bacteria rate(P＜0,05).External susceptibility test Showed. most of the HAP pathogens wereresistant to theantimicrobials commonly used in clinic. Vancomycinwassensitive to all of the isolated G~+ cocci at a rate of 100％, Carbepenemwas sensitive to most of the G~- bacilli except StenotrophomonasMaltophilia. Cefoperazone-Sulbactarn and had high antibioticactivity to most of the G- bacilli.The prognosis of HAP was poor. The crudemortalitywas 7.94％, i.t was3.10％in mild-to moderate HAP group, and 23.85％in severe HAP(P＜0.05).CONCLUSIONS:HAP occurred at a rate of 1.08％in our hospital. Most of the patientswere old with several underlying diseases and prior broad-spectrumantibiotics exposure. The core pathogens of HAP in our hospital areAcinetobacter spp, Klebsiella pneumonia, Pseudomonas aeruginosa, Staphyloccusaureus, Staphyloccus epidermidis, Enterobacter and Blastomyces albicans.Non-fermenters and drug resistant pathogens isolation rate were higher,prolongation of hospital stay, the broad-spectrum antibiotics, and severeHAP were risk factors for drug resistant bacteria. The prognosis of HAPwas poor. The crude mortality was 7.97％, it was 3.10％in mild-to moderateHAP group, and 23.85％in severe HAP.