Distribution and Drug Resistance of Pathogens Causing Hospital-Acquired Pneumonia and Risk Factors Analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

BAIXuedong ,  BILiyan

Department of VIP, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R.China;

Corresponding?author：

BILiyan, Email: biliyan@163.com

Keywords：

Hospital-acquired pneumonia; Risk factors; Pathogens; Antibiotics

DOI：

10.7507/1671-6205.201608006

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Objective To study the distribution and drug resistance of pathogens causing hospital-acquired pneumonia (HAP) and explore the related risk factors, so as to provide valuable clinical reference for prevention and treatment of HAP. Methods A case-control study was conducted in a 3700-bed tertiary hospital. Nosocomial infections reported from January 2014 to December 2014 were investigated. A total of 419 inpatients with HAP were enrolled in as a study group, and 419 inpatients without nosocomial infection in the same period and department, with same gender, underlying diseases, and same age, were chosen as a control group. Risk factors of HAP, distribution and drug resistance of pathogens of HAP were analyzed. Results The incidence rate of HAP was 0.62% and the mortality rate was 19.81%. Multivariate analysis identified chronic lung diseases, admission in ICU, two or more kinds of antibiotics used, hospitalization time≥5 days, cerebrovascular disease, and mechanical ventilation were significant risk factors. Totally 492 strains of pathogens were isolated, including 319 strains of gram-negative bacteria, 61 strains of gram-positive bacteria, 112 strains of fungi.Acinetobacter baumannii,Klebsiella pneumonia,Candida albicans,Pseudomonas aeruginosa,Candida glabrata ranked the top five predominant pathogens. Drug resistance rates ofAcinetobacter baumannii to commonly used antibiotics were higher than 75%. Drug resistance rates ofKlebsiella pneumoniae to piperacillin and third-generation cephalosporin were higher than 50%. Conclusions HAP prevails in patients with hospitalization time≥5 days, admission in ICU, cerebrovascular diseases, two or more antibiotics combined used, chronic lung diseases, and mechanicalventilation. It is associated with increased length of hospital stay, decreased quality of life, and elevated morbidity and mortality. The main pathogens of HAP are Gram-negatives.Acinetobacter baumannii andKlebsiella pneumoniae are resistant to the common antibiotics in different degree.

Citation： BAIXuedong, BILiyan. Distribution and Drug Resistance of Pathogens Causing Hospital-Acquired Pneumonia and Risk Factors Analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(1): 23-28. doi: 10.7507/1671-6205.201608006 Copy

1.	?Sopena N, Heras E, Casas I, et al. Risk factors for hospital-acquired pneumonia outside the intensive care unit: a case-control study. Am J Infect Control, 2014, 42(1): 38-42.
2.	阮海燕, 周興輝, 曹奇峰. 醫院獲得性肺炎的病原學分布及危險因素分析. 中華醫院感染學雜志, 2011, 21(18): 3957-3959.
3.	史建梅. 醫院獲得性肺炎危險因素分析及護理措施. 中國醫藥指南, 2013,11 (10): 710-711.
4.	American Thoracic Society Documents, Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
5.	Thompson DA, Makary MA, Dorman T, et al. Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg, 2006, 243(4): 547-552.
6.	金珍. 醫院獲得性肺炎危險因素及用藥分析. 中華醫院感染學志, 2012,22 (20): 4467-4468.
7.	侯愛紅. 醫院獲得性肺炎危險因素分析. 中華醫院感染學雜志, 2002, 12(10): 742-743.
8.	李雅立. 醫院獲得性肺炎的危險因素分析及干預措施. 中國誤診學雜志, 2011,11(23): 5645-5646.
9.	龍定梅. 醫院獲得性肺炎的危險因素及病原菌分布. 臨床肺科雜志, 2012,17 (12): 2275-2276.
10.	Dulhunty JM, Webb SA, Paterson DL, et al. A survey of antibiotic prescribing practices in Australian and New Zealand intensive care units. Crit Care Resusc, 2010, 12(3): 162-170.
11.	Vanhems P, Bénet T, Voirin N, et al. Early-onset ventilator-associated pneumonia incidence in intensive care units: [ a surveillance-based ] study. BMC Infect Dis, 2011, 11: 236.
12.	Herzig SJ, Howell MD, Ngo LH, et al. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA, 2009, 301(20): 2120-2128.
13.	Chung DR, Song JH, Kim SH, et al. High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia. Am J Respir Crit Care Med, 2011, 184(12): 1409-1417.
14.	施曉群, 孫景勇, 倪語星, 等. 2011 年中國 C H INET 銅綠假單胞菌耐藥性監測. 中國感染與化療雜志, 2013, 13(3): 218-221.
15.	李茉莉, 潘頻華, 胡成平. 呼吸 ICU 醫院獲得性肺炎的病原菌分布與致病菌耐藥性的變遷.中南大學學報(醫學版), 2013, 38(3): 251-257.
16.	唐貞明, 凌宙貴, 劉衛, 等. 醫院與社區獲得性肺炎的病原菌分布及耐藥性. 中華醫院感染學雜志, 2014, 24(5): 1092-1094.
17.	Fagon JY, Chastre J, Wolff M, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med, 2000, 132(8): 621-630.

1. ?Sopena N, Heras E, Casas I, et al. Risk factors for hospital-acquired pneumonia outside the intensive care unit: a case-control study. Am J Infect Control, 2014, 42(1): 38-42.
2. 阮海燕, 周興輝, 曹奇峰. 醫院獲得性肺炎的病原學分布及危險因素分析. 中華醫院感染學雜志, 2011, 21(18): 3957-3959.
3. 史建梅. 醫院獲得性肺炎危險因素分析及護理措施. 中國醫藥指南, 2013,11 (10): 710-711.
4. American Thoracic Society Documents, Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med, 2005, 171(4): 388-416.
5. Thompson DA, Makary MA, Dorman T, et al. Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg, 2006, 243(4): 547-552.
6. 金珍. 醫院獲得性肺炎危險因素及用藥分析. 中華醫院感染學志, 2012,22 (20): 4467-4468.
7. 侯愛紅. 醫院獲得性肺炎危險因素分析. 中華醫院感染學雜志, 2002, 12(10): 742-743.
8. 李雅立. 醫院獲得性肺炎的危險因素分析及干預措施. 中國誤診學雜志, 2011,11(23): 5645-5646.
9. 龍定梅. 醫院獲得性肺炎的危險因素及病原菌分布. 臨床肺科雜志, 2012,17 (12): 2275-2276.
10. Dulhunty JM, Webb SA, Paterson DL, et al. A survey of antibiotic prescribing practices in Australian and New Zealand intensive care units. Crit Care Resusc, 2010, 12(3): 162-170.
11. Vanhems P, Bénet T, Voirin N, et al. Early-onset ventilator-associated pneumonia incidence in intensive care units: [ a surveillance-based ] study. BMC Infect Dis, 2011, 11: 236.
12. Herzig SJ, Howell MD, Ngo LH, et al. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA, 2009, 301(20): 2120-2128.
13. Chung DR, Song JH, Kim SH, et al. High prevalence of multidrug-resistant nonfermenters in hospital-acquired pneumonia in Asia. Am J Respir Crit Care Med, 2011, 184(12): 1409-1417.
14. 施曉群, 孫景勇, 倪語星, 等. 2011 年中國 C H INET 銅綠假單胞菌耐藥性監測. 中國感染與化療雜志, 2013, 13(3): 218-221.
15. 李茉莉, 潘頻華, 胡成平. 呼吸 ICU 醫院獲得性肺炎的病原菌分布與致病菌耐藥性的變遷.中南大學學報(醫學版), 2013, 38(3): 251-257.
16. 唐貞明, 凌宙貴, 劉衛, 等. 醫院與社區獲得性肺炎的病原菌分布及耐藥性. 中華醫院感染學雜志, 2014, 24(5): 1092-1094.
17. Fagon JY, Chastre J, Wolff M, et al. Invasive and noninvasive strategies for management of suspected ventilator-associated pneumonia. A randomized trial. Ann Intern Med, 2000, 132(8): 621-630.

Chinese Journal of Respiratory and Critical Care Medicine

Distribution and Drug Resistance of Pathogens Causing Hospital-Acquired Pneumonia and Risk Factors Analysis

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