A Retrospective Cohort Study Of Hospital-acquired Pneumonia In Department Of Neurology

Objective:A retrospective cohort study of the influence of time of hospital-acquired pneumonia on pathogen constitution and antibiotic-resistance of hospital-acquired pneumonia ( HAP ) and objective to indicate clinical doctors to use antibioltics reasonably.Methods: Cases of HAP were patients hospitalized in Department of Neurology of Tongji Hospital. These patients were hospitalized from January 2004 to May 2006, and the diagnosis of HAP was made based on positive respiratory specimen cultures. Clinical data including time of HAP onset, severity of illness, risk factors, isolated bacteria and antimicrobial susceptibility were collected and analyzed. Statistical analysis was performed with the SPSS 13.0 software.Results: A total of 93 cases of HAP were recruited, including 23 cases of early-onset pneumonia ( time of onset≤5 d) , 54 cases of middle-onset pneumonia ( time of onset 6-14 d) and 16 cases of late-onset pneumonia ( time of onset≥15 d). The rate of coma ( P =0.006) ;incision of trachea ( P =0.000). A total of 225 strains of bacteria were isolated, the most common pathogens being Pseudomonas aeruginosa (53 strains) , Staphylococcus aureus (33 strains) , acinetobacter baumanii (25 strains ) , Enterobacter cloacae (21 strains ) and stenotrophomo-nas maltophilia (18 strains).Early-onset HAP were more commonly caused by stenotrophomo-nas maltophilia (20% ) ,while the main etiologic agents forlate-onset HAP were Pseudomonas aeruginosa (43.7% ) and Methicillin-resistant S taphylococcus aureus ( 9.86% ). The antibacterial activity was influenced by duration of hospitalization, In early-onset cases the sensitivity of was high, But in late-onset cases, it was low.Conclusions : There was significant difference in the pathogen constitution and antibiotic-resistance among early-onset, middle-onset and late-onset cases of HAP. The sensitivity of antibiotics was high in early-onset cases.