Liu You-ning, Cao Bin, Wang Hui, Chen Liang-an, She Dan-yang, Zhao Tie-mei, Liang Zhi-xin, Sun Tie-ying, Li Yan-ming, Tong Zhao-hui, Wang Zhen, He Bei, Yang Wei, Qu Jie-ming, Li Xiang-yang, Chen Rong-chang, Ye Feng, Kang Jian, Li Er-ran, Chen Ping, Zheng Yan, Ma Zhong-sen, Ren Jin, Shi Yi, Sun Wen-kui, Feng Yu-lin, Fan Hong, Jiang Shu-juan, Zhang Song, Xiong Sheng-dao, Zuo Peng, Wang Zhan-wei
Department of Respiratory Medicine, the General Hospital of PLA, Beijing, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2012 Oct;35(10):739-46.
To investigate the etiology and clinical characteristics of hospital-acquired pneumonia (HAP) in China and to provide evidence for appropriate therapy.
We performed a prospective multicenter study in 13 Chinese urban tertiary hospitals. All HAP cases diagnosed at respiratory general ward and respiratory intensive care unit (RICU) from August 2008 to December 2010 were studied. Epidemiological data, etiology and clinical characteristics of enrolled patients were collected. Sputum or tracheal aspirate and blood cultures, Legionella antibodies and Streptococcus pneumoniae urinary antigen tests were performed. Bacteria to antimicrobial susceptibility test was performed.
A total of 610 cases of HAP were diagnosed during the study, with an overall incidence of 1.4% among 42 877 hospitalized patients, while the incidence was 0.9% (362/41 261) in respiratory general ward and 15.4% (248/1616) in RICU. 93.9% (573 cases) of patients had at least one underlying disease, and 91.0% (555 cases) had exposure to at least one antimicrobial agent within 90 days prior to HAP diagnosis. Pathogens were identified in 487 patients, with Acinetobacter baumannii [30.0% (183/610)], Pseudomonas aeruginosa [22.0% (134/610)], Staphylococcus aureus [13.4% (82/610)] and Klebsiella pneumonia [9.7% (59/610)] being the most common pathogens. Eighteen patients (3.0%) had infection with fastidious bacteria. A. baumannii and S. aureus were the more frequent pathogens in the ventilator-associated pneumonia (VAP) cases [50.5% (97/192) and 21.4% (41/192)] as compared to non-VAP cases [20.6% (86/418) and 9.8% (41/418), P < 0.01]. A. baumannii and S. aureus were also frequent pathogens in cases with a score of more than 20 by the acute physiology and chronic health evaluation II (APACHEII) scoring [45.7% (69/151) and 20.5% (31/151)], as compared to cases with a score of less than 20 of APACHE II [24.8% (114/459) and 11.1% (51/459), P < 0.01]. A. baumannii showed high resistance rates to carbapenems [more than 70% (109/142)], and the susceptibility to cefoperazone/sulbactam, polymyxin B and tigecycline were 40.8% (58/142), 99.3% (141/142) and 95.8% (136/142) respectively. Resistance rates of P. aeruginosa to meropenem and imipenem were 48.8% (40/82) and 70.7% (58/82) respectively. Methicillin-resistant S. aureus (MRSA) accounted for 87.8% (43/49) in all strains of S. aureus. Mortality rate of VAP cases was 34.5% (61/177), significantly more than that of HAP patients [22.3% (135/605), P < 0.05]. The average hospital stay of patients with HAP was (23.8 ± 20.5) days, significantly more than that of the average for inpatients [(13.2 ± 13.6) days, P < 0.01] during the study period. Mean costs of HAP were (108 950 ± 116 608) yuan, significantly higher than the average hospital costs of respiratory inpatients (17 999 ± 33 364) yuan.
Among Chinese patients hospitalized in urban tertiary medical centers, HAP incidence and mortality rate were high, which increased the patients' hospital stay and the medical costs. Common pathogens were A. baumannii, P. aeruginosa, S. aureus and K. pneumonia. The common bacteria of HAP in China showed high resistance rates to antibiotics.
探讨中国医院获得性肺炎（HAP）的病因及临床特征，为合理治疗提供依据。
我们在13家中国城市三级医院进行了一项前瞻性多中心研究。对2008年8月至2010年12月在呼吸普通病房和呼吸重症监护病房（RICU）诊断的所有HAP病例进行研究。收集入选患者的流行病学数据、病因及临床特征。进行痰或气管吸出物及血培养、军团菌抗体及肺炎链球菌尿抗原检测。对细菌进行抗菌药敏试验。
研究期间共诊断出610例HAP病例，在42877例住院患者中的总发病率为1.4%，而在呼吸普通病房的发病率为0.9%（362/41261），在RICU为15.4%（248/1616）。93.9%（573例）的患者至少有一种基础疾病，91.0%（555例）在HAP诊断前90天内至少使用过一种抗菌药物。487例患者鉴定出病原体，鲍曼不动杆菌[30.0%（183/610）]、铜绿假单胞菌[22.0%（134/610）]、金黄色葡萄球菌[13.4%（82/610）]和肺炎克雷伯菌[9.7%（59/610）]是最常见的病原体。18例患者（3.0%）感染苛养菌。与非呼吸机相关性肺炎（VAP）病例[20.6%（86/418）和9.8%（41/418）]相比，鲍曼不动杆菌和金黄色葡萄球菌在VAP病例中更常见[50.5%（97/192）和21.4%（41/192），P<0.01]。与急性生理与慢性健康状况评估II（APACHEII）评分小于20分的病例[24.8%（114/459）和11.1%（51/459）]相比，鲍曼不动杆菌和金黄色葡萄球菌在APACHEII评分大于20分的病例中也很常见[45.7%（69/151）和20.5%（31/151），P<0.01]。鲍曼不动杆菌对碳青霉烯类药物的耐药率较高[超过70%（109/142）]，对头孢哌酮/舒巴坦、多粘菌素B和替加环素的敏感性分别为40.8%（58/142）、99.3%（141/142）和95.8%（136/142）。铜绿假单胞菌对美罗培南和亚胺培南的耐药率分别为48.8%（40/82）和70.7%（58/82）。耐甲氧西林金黄色葡萄球菌（MRSA）在所有金黄色葡萄球菌菌株中占87.8%（43/49）。VAP病例的死亡率为34.5%（61/177），显著高于HAP患者[22.3%（135/605），P<0.05]。HAP患者的平均住院天数为（23.8±20.5）天，显著长于研究期间住院患者的平均住院天数[（13.
