Clinical Analysis Of Hospital Acquired Pneumonia In The Elderly

Aims:To investigate the clinical characteristics etiological distribution characteristics,drug resistance and outcomes of acquired pneumonia in the elderly patients in our hospital,and to provide reference for clinicians to identify early,deal with timely,rational drug use and improve clinical outcomes.Methods:From June 2017 to January 2018,85 cases of geriatric HAP patients who were not in ICU,and whose respiratory specimens were positive were included in our hospital,and their medical history,sputum culture,drug sensitivity results and outcomes were analyzed.All the selected patients were older than 60 years old,and pathogenic bacteria were successfully isolated from their sputum.The diagnostic criteria were mainly based on the guidelines for diagnosis and treatment of hospital-acquired pneumonia issued by the ministry of health of China.Exclusion criteria were including:1.Patients with CAP;2.Patients with severe illness admitted to the ICU.Clinical observation indexes included:(1)the age and gender of the study population;(2)the clinical features,signs,inflammatory indicators,pulmonary imaging manifestations,etiological characteristics and drug resistance;(3)antibiotics exposure;(4)complications during the course of the disease;(5)types and quantities of basic diseases;(6)susceptibility factors;(7)outcome:(1)The criteria for cure were complete disappearance of symptoms,complete recovery of inflammatory markers and pulmonary imaging.;(2)The standard for improvement was that the cough and sputum symptoms of the patient are improved,but not completely disappeared,or the inflammatory index of the patient is decreased,or the pulmonary inflammation in the reexamination of imaging examination is reduced than before,but not completely disappeared;(3)The standard of no improvement was that the patient still had repeated cough,expectoration and fever after long-term antibiotic treatment,and no improvement in inflammatory index or imaging examination;(4)The patient died.Result:(1)eighty-five elderly HAP patients were enrolled,aged 60-95 years,with an average age of(76.62±9.26)years old,accounting for 75.3%of males and 24.7% of females.(2)The proportion of geriatric suffering from three or more basic diseases was 44.7%.(3)The chief manifestations were fever(36.5%),cough or phlegm(49.4%),apathy(14.1%),rale(44.7%),leukocytosis(44.7%),neutrophil(72.9%)and inflammation(71.8%).(4)The shortest hospitalization time was 8 days and the longest was 267 days.The average hospitalization time was(55.46±53.24)days.(5)The antibiotic use time was the shortest of 3 days and the longest of 70 days.The average time of antibiotic use was(18.78 +12.33)days.(6)A total of 96 pathogenic bacteria were isolated,of which 61 were gram-negative bacteria,accounting for 63.5%.followed by gram-positive bacteria,accounting for 20.8%.In addition,Corynebacterium striatum were found in the positive bacteria,which were rarely reported in the past Among them.and fungi accounting for 14.6%.19 were pseudomonas aeruginosa,14 were haemophilus influenzae,12 were acinetobacter baumannii,9 were Staphylococcus aureus,7 were Escherichia coli,7 were klebsiella pneumoniae and 7 were Candida albicans,accounting for 19.8%,14.6%,12.5%,9.4%,7.3%,7.3% and 7.3% respectively.(7)The resistance rates of pseudomonas aeruginosa,acinetobacter baumannii,klebsiella pneumoniae and Escherichia coli to ampicillin were 100%.The resistance rates of pseudomonas aeruginosa,acinetobacter baumannii and Escherichia coli to carbapenems were higher than 42%.(8)Outcome: After treatment,the cure rate was 1.2%,the mortality rate was 16.5%,and the improvement rate was77.6%.Conlcution:Elderly patients with multiple basic diseases,HAP symptoms and signs are not obvious.Gram-negative bacteria are the main pathogens with high resistance rate,long treatment time,difficult treatment and high mortality.