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Objective: To investigate the respiratory care unit late-onset hospital-acquired pneumonia (Late-onset Hospital-AcquiredPheumonia, L-HAP) the clinical features, risk factors, etiology and outcome of such distribution. Methods: A retrospective case-control study, collected in our hospital respiratory intensive care unit L-HAP 30 patients included in the HAP group; collect hospitalization period and the base case is not comparable HAP occurred in 30 patients, included in the control group. By comparison between two groups, L-HAP study the clinical features and risk factors. According to L-HAP onset patients were stratified study different periods occurring L-HAP hospitalized factors affecting pathogen distribution and antibiotic use. Results: L-HAP in the first 6 days after admission - the first 53 days occurred, the average of (22.1 ± 12.7) days of occurrence. Promote the onset of single L-HAP factors include unconsciousness, often occurs aspiration, tracheal intubation or tracheostomy receiving mechanical ventilation, hypoalbuminemia, and prolonged use of proton pump inhibitors. Logistic multivariate analysis showed that mechanical ventilation, hypoalbuminemia is an independent risk factor of HAP. Compared with control group, HAP patients hospitalization time, the use of antibiotics in the hospital during the time were significantly prolonged, mortality also increased significantly. L-HAP in patients with Gram-negative bacilli accounted for 71.4%. Acinetobacter baumannii infection, Pseudomonas aeruginosa and Staphylococcus aureus L-HAP mortality were 62.5%, 28.6% and 25.0%. Staging studies have shown that different periods occurring L-HAP hospitalized patient sex, age, underlying disease was similar. Different periods occurring L-HAP hospitalized patients seven days before the onset of the different types of antibiotics, the continuous use of antibiotics in the case were the first one (6.2 ± 1.3) days, to the third and fourth generation cephalosporins most commonly used; Section 2 ( 6.3 ± 1.4) days, to the third and fourth generation cephalosporins, β-lactam / enzyme inhibitors and fluoroquinolones most commonly used; Section 3 (6.8 ± 0.4) days, to the third and fourth generation cephalosporins and carbon Penicillium vinyl most commonly used. L-HAP in patients with negative sputum culture accounted for the proportion of onset were 11.1%, 16.7%, 66.7%. The insufficiency of the same pathogen, the first one to Acinetobacter baumannii dominated the first two Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus, the first three with Pseudomonas aeruginosa Aeromonas based. Conclusion: Mechanical ventilation, hypoalbuminemia is happening L-HAP independent risk factors; happen L-HAP significantly promote the patients died, increased hospital stay and increased use of antibiotics. L-HAP premorbid Pathogenic Bacteria with antibiotic closely correlated Butongzhuyuan 时段 pathogens not identical.
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