摘要
目的 探讨社区获得性肺炎（CAP）治疗失败的原因和危险因素.方法 回顾性分析2006年1-12月拟诊CAP入院病例378例,以无反应性肺炎及进展性肺炎定义治疗失败,以此分析治疗失败CAP患者的临床特征,探讨治疗失败的原因,并进行高危因素分析.结果 378例CAP患者中,治疗失败50例,其中无反应性肺炎32例,进展性肺炎18例.分析失败原因：感染性原因35例,占70%;非感染性原因11例,占22%;无法明确原因4例,占8%.50例患者中共有9例死亡（18%）,8例为感染性原因,1例为无法明确原因.C反应蛋白、多叶受累、白蛋白〈30g/L、肾功能损害、肝功能损害均与CAP治疗失败有关,其中多叶受累、白蛋白〈30 g/L、肾功能损害是CAP治疗失败独立的危险因素.结论 CAP治疗失败及死亡的主要原因是感染性原因,多为耐药菌株感染.
Objective To determine the causes and risk factors of antimicrobial treatment failure in patients with community-acquired pneumonia（CAP）. Methods Hospitalized adults with CAP from January 2006 to December 2006 were analyzed retrospectively. Treatment failure was defined as appearance of nonresponding pneumonia and progressive pneumonia. Patient＇s clinical features were analyzed. Results All of 378 patients were involved in this study. Total antimicrobial treatment failure was happened in 50 patients（32 patients with non-responding pneumonia and 18 patients with progressive pneumonia）. The causes were infectious （35 patients,70% ）, non-infectious （11 patients,22% ） and undetermined （4 patients,8% ）.Mortality of antimicrobial treatment failure was 18%（9/50, 8 patients died of infectious cause, 1 patient had no clear cause of death）. Stepwise Logistic regression analysis showed that C-reactive protein, multilobar pneumonia,albumin 〈 30 g/L,renal function lesion,liver function lesion were related with antimicrobial treatment failure. Independent factors of treatment failure were multilobar pneumonia （P= 0.002） ,albumin 〈30 g/L（P = 0.001 ） and renal function lesion （P = 0.000）. Conclusion The major challenge associated with antimicrobial treatment failure in hospitalized patients with CAP is infection, most of which is infection of drug resistant strain.
出处
《中国医师进修杂志》
2010年第19期18-21,共4页
Chinese Journal of Postgraduates of Medicine
关键词
社区获得性感染
治疗失败
危险因素
Community-acquired infections
Treatment failure
Risk factors
