| PurposeTo collect and analyze the results of sputum culture and basic conditions of patients with adult hospital acquired pneumonia(HAP)in our hospital from October 2009 to October 2017,in order to understand the related influencing factors of positive sputum culture of adult hospital acquired pneumonia,and to retrospectively analyze the results of sputum culture and drug sensitivity test,and to understand the distribution of pathogenic bacteria and the change of drug resistance in patients with hospital acquired pneumonia.To provide reference and basis for clinical rational drug use.MethodsA retrospective study was conducted on HAP/VAP diagnosed in the Third Affiliated Hospital of Anhui Medical University from October 2009 to October 2017 in accordance with the diagnostic criteria of the Guidelines for the Treatment of Hospital-acquired Pneumonia issued by the American Thoracic Society and the Infectious Society in 2005.All patients were over 18 years old with complete data.Clinical data of all patients were collected,including gender,age,underlying diseases,antibiotic use and the use of antibiotics.The results of sputum culture and susceptibility test were analyzed.The data were analyzed by SAS 9.4 statistical software to understand the related factors of positive sputum culture in adult hospital acquired pneumonia.ResultsFrom October 2009 to October 2017,1905 adult patients with HAP/VAP were clinically diagnosed.1266 patients collected at least one sputum specimens from the2 nd to 7th day after the diagnosis of HAP.669 cases of sputum culture results were positive.Among them,897 males,369 females,285 patients with chronic respiratory diseases,294 surgical patients,221 cancers,388 patients with antibiotics,50 patients with heart failure,76 patients with immunosuppressive agents,and 76 patients with sugar.290 cases of urinary diseases,191 cases of malnutrition,42 cases of renal replacement therapy,82 cases of intravenous hormone use,221 cases of invasive mechanical ventilation.For the positive results,the median between specimen collection and culture identification was 4 days(25%-75%,3-5).Multivariate logistic regression showed that surgery(P < 0.001),high use of antibiotics(P < 0.001),malnutrition(P < 0.001)and invasive mechanical ventilation(P < 0.001)were the related factors of sputum culture positive.A total of 2646 specimens were collected and 1579 strains of pathogens were cultured.922 strains were isolated after eliminating duplicate strains in the same part of the same patient.Acinetobacter baumannii(242 strains),Pseudomonas aeruginosa(199strains),Klebsiella pneumoniae(129 strains),Staphylococcus aureus(127 strains).The isolation rate of carbapenem-resistant Acinetobacter baumannii(CRAB)increased year by year from 2011 to 2014,and declined in the past three years.The isolation rate in2017 was 75.0%.The isolation rate of carbapenem-resistant Pseudomonas aeruginosa(CRPA)decreased year by year from 2013 to 2017.The isolation rate in 2017 was16.7%.The total detection rate of methicillin-resistant Staphylococcus aureus was59.1%.ESBLs-producing strains were detected by ESBLs.The total detection rate of Enterobacteriaceae was 16.1%.The total detection rate of carbapenem-resistant Enterobacteriaceae bacteria was 13.7%.In recent three years,the isolation rate increased year by year.In 2017,the isolation rate was 20.0%.ConclusionsThe results of sputum culture in adult patients with HAP were influenced by surgical operation,large use of antibiotics,malnutrition and invasive mechanical ventilation.Gram-negative bacteria were the main pathogens detected in sputum culture.The detection rate of CRAB decreased slightly in recent three years.CRPA decreased year by year from 2013 to 2017.The detection rate of methicillin-resistant Staphylococcus aureus was 59.1%,and that of ESBLs-producing Enterobacteriaceae was 16.1%.The drug resistance of pathogenic bacteria needs to be further monitored. |
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