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学科主题: 急诊医学
题名:
健康护理相关性肺炎感染多重耐药菌危险分层的分析
作者: 沈佳佳
答辩日期: 2016-05-20
导师: 熊辉
专业: 急诊医学
授予单位: 北京大学
授予地点: 北京大学第一临床医学院
学位: 硕士
关键词: 健康护理相关性肺炎 ; 多重耐药菌 ; 危险分层 ; 初始抗菌药物治疗
其他题名: Analysis of healthcare-associated pneumonia using risk factors for multidrug-resistant pathogens
分类号: R563.1
摘要:

目的 评价感染多重耐药菌(multidrug-resistant pathogen,MDR)的危险分层模型在健康护理相关性肺炎(healthcare-associated pneumonia,HCAP)中预测MDR感染风险及指导初始治疗抗菌药物选择的价值。

方法 对232例HCAP患者回顾性应用一个感染MDR危险分层模型进行分层,比较不同分层内感染MDR的比例、抗菌药物使用情况、转归。

结果 具有≥2个感染MDR危险因素的患者感染MDR的比例高于具有≤1个危险因素的患者(19.4% vs 6.3%, P<0.05)。重症HCAP患者感染MDR的比例显著高于非重症患者(39.6% vs 7.8%, P<0.001)。在具有≥2个危险因素的非重症肺炎患者中,初始治疗使用覆盖MDR病原体的广谱抗菌药物能够降低初始治疗失败率(10.9% vs 27.5%, P<0.05),不能缩短住院时长,不能降低死亡率。

结论 基于肺炎严重程度以及感染MDR危险因素的分层模型有助于预测感染MDR的风险,可用于指导HCAP初始抗菌药物的选择。

英文摘要:

Objective To assess the value of an algorithm in predicting multidrug-

resistant pathogens(MDR) infection and guiding empirical antibiotic therapy in

healthcare-associated pneumonia(HCAP).

Methods We retrospectively applied an algorithm based on pneumonia severity and the presence of risk factors for MDR in 232 HCAP patients and compared microbiology, antibiotics use and prognosis in different subgroups.

Results Using the proposed algorithm, HCAP patients with ≥ 2 MDR risk factors(n=155), one of which was severity of illness, vs HCAP patients with 0-1 risk factor (n=77) had a higher frequency of MDR pathogens(19.4% vs 6.3%; P<0.05). Severe pneumonia(n=53) had a significantly higher frequency of MDR pathogens than non-severe (n=179)patients(39.6% vs 7.8%;P<0.001). In non-severe patients with ≥ 2 MDR risk factors(n=106), those received a hospital acquired pneumonia (HAP) empirical treatment(n=55) vs those received a community acquired pneumonia (CAP) empirical treatment (n=51)had a lower initial treatment failure rate(10.9% vs 27.5%; P<0.05), but similar length of stay (22.4±19.5 vs 18.7±20.5; P=0.339)and mortality(3.6% vs 3.9%; P=1.0).

Conclusions The algorithm based on pneumonia severity and presence of risk factors for MDR pathogens is a useful tool in predicting MDR infection and guiding empirical antibiotic therapy.

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/125267
Appears in Collections:北京大学第一临床医学院_学位论文

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作者单位: 北京大学第一临床医学院

Recommended Citation:
沈佳佳. 健康护理相关性肺炎感染多重耐药菌危险分层的分析[D]. 北京大学第一临床医学院. 北京大学. 2016.
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