Analysis Of Distribution And Drug Resistance Of Etiology Causing Hospital-acquired Pneumonia And Risk Factors

OBJECTIVE:To study the distribution and drug resistance of etiology causing Hospital-acquired pneumonia(HAP)and explore the related risk factors,so as to provide valuable clinical reference for preventing and treating HAP efficiently.METHODS:a case-control study was conducted in a tertiary hospital with3700-bed.nosocomial infections reported from Jan 2014 to Dec 2014 was investigated.The 419 inpatients with HAP were enrolled in as the study group,the 419 same period,same gender,same department,same underlying disease,same age inpatients without nosocomial infection were chosen as the control group.risk factors of HAP,distribution and drug resistance of pathogens of HAP and VAP were analyzed.RESULT: The incidence rate of HAP was 0.62% and the fatality rate was19.81%.Univariate analysis identified Chronic lung disease,invasive procedure,admitted in ICU,two or more kinds of antibiotics combined,antacid therapy,hospitalization time≥5days,cerebrovascular disease,mechanical ventilation had a significantly frequency.Multivariate analysis identified all the factors above were significant risk factors expect invasive procedure and antacid therapy.multiple pathogen infections accounted for 131(31.26%)cases.totally 492 strains of pathogens were isolated,including 319 strains of gram-negative bacteria(64.84%),61 strains of gram-positive bacteria(12.40%),112 strains of fungi(22.76%),Acinetobacter baumannii(19.11%),Klebsiella pneumonia(17.28%),Candida albicans(13.82%),Pseudomonas aeruginosa(10.77%),Candida glabrata(5.89%)ranked the top five.There were 39(35.78%)case of single pathogen infections and 70(64.22%)case of multiple pathogen infections in 109 VAP,totally 251 strains of pathogens were isolated,Acinetobacter baumannii(24.70%),candida albicans(13.94%),Klebsiella pneumoniae(12.35%),Pseudomonas aeruginosa(10.76%),candida glabrata(6.77%)ranked the top five.Drug resistance rates of Acinetobacter baumannii to commonlyused antibiotics were higher than 75%,but lower than 25% to Imipenem and Sulperazon.Drug resistance rates of Klebsiella pneumoniae to Pieracillin and third-generation cephalosporin were higher than 50%,but lower than 20% to Imipenem and Sulperazon Drug resistance rates of Pseudomonas aeruginosa to commonly used antibiotics such as Ceftazidime,Pieracillin,Levofloxacin were 20%around.The candida albicans and The candida glabrata to fluconazole were lower than 20%.Staphylococcus was highly susceptible to vancomyci,but severly resistant to penicillin with a rate of 81.48%.Conclusions HAP prevails in patients with hospitalization time≥5days,admitted in ICU,cerebrovascular disease,two or more antibiotics combined,chronic lung disease,mechanical ventilation,it has an elevated morbidity and mortality and is associated with increased length of hospital stay and decreased quality of life.The main pathogens of HAP are Gram-negatives,followed by fungi.VAP patients are more likely to be multiple pathogen infections with an increasing proportion of fungi.Acinetobacter baumannii and Klebsiella pneumoniae were resistant to the common antibiotics in different degree.