关键词: 医疗保健相关性肺炎, 急诊处理, 病原体, 微生物敏感性试验

Abstract: Objective　To analyze the results of the pathogens distribution and antibiogram in patients with emergency healthcare-associated pneumonia （HCAP），so as to provide the basis for rational use of antibiotics in the region.Methods　A total of 783 emergency inpatients with HCAP admitted to the First Affiliated Hospital of Xinjiang Medical University，according to the age distribution，were divided into the younger group（364 cases） and the elderly group（419 cases）from November 2014 to April 2017.The baseline data，specimen culture，pathogens distribution and antibiogram were analyzed.Results　The elderly group was significantly more likely to have hypertension，cardiovascular disease，diabetes mellitus，chronic lung disease，solid organ malignancy，≥ 2 basic diseases and high systolic pressure （P<0.05），whereas younger group were significantly more likely to have nervous system disorders，hematologic deisease，rheumatologic disease，peripheral vascular disease and lower temperature than the elderly group （P<0.05）．Among the 783 patients，783 strains were detected，of which 573 were from sputum culture （73.2%），171 from tracheal or bronchial aspirates （21.8%） and 39 from bronchoalveolar lavage fluid （5.0%）．There were 27 kinds of Gram-negative bacilli，9 kinds of Gram-positive cocci and 1 kind of fungus.Gram-negative bacteria were the most common pathogens in both groups〔86.0%（313/364） and 85.2%（357/419）〕．The order of pathogenic bacteria was Acinetobacter baumannii 〔25.3%（92/394） and 29.1%（122/419）〕，Klebsiella pneumoniae 〔25.8%（94/364） and 21.0%（88/419）〕，Pseudomonas aeruginosa 〔12.1%（44/364） and 9.3%（39/419）〕，Staphylococcus aureus 〔8.5%（31/364） and 8.4%（35/419）〕 and Escherichia coli 〔5.8%（21/364） and 8.8%（37/419）〕，with the drug resistance of Acinetobacter baumannii the most critical.The most Gram negative bacilli was generally drug-resistant to Penicillins，the first and second generation cephalosporin，and sensitive to carbapenem，sulfamethoxazole and polymyxin B.The drug resistance rate of Klebsiella pneumoniae and Escherichia coli to the third generation cephalosporin were 26.4%，62.1%，respectively，and the drug resistance rate of Acinetobacter baumannii，Klebsiella pneumoniae，Pseudomonas aeruginosa and Escherichia coli to carbapenem were 71.5%，1.1%，30.1%，1.7%，respectively.Conclusion　The majority of HCAP patients were elderly men.Age has little influence on the etiology of HCAP.The distribution and drug resistance of HCAP pathogens in this region have regional characteristics，clinicians should rationally use antibiotics according to specific circumstances.

Key words: Healthcare-associated pneumonia, Emergency treatment, Pathogens, Microbial sensitivity tests