ĐẶC ĐIỂM LÂM SÀNG, VI SINH VÀ ĐỀ KHÁNG KHÁNG SINH CỦA VI KHUẨN GÂY VIÊM PHỔI BỆNH VIỆN TẠI KHOA HÔ HẤP BỆNH VIỆN NHÂN DÂN 115

Abstract

Background: Hospital-acquired pneumonia (HAP) is one of the most common nosocomial infections and a leading cause of mortality among hospitalized patients. Early initiation of appropriate antimicrobial therapy guided by local resistance patterns is essential for effective management. This study aimed to describe the clinical characteristics, microbiological profile, and antimicrobial resistance patterns of pathogens causing HAP in the Respiratory Department of People’s Hospital 115. Methods: A descriptive case series was conducted among 38 patients diagnosed with HAP between March 2024 and September 2024. HAP was defined according to the 2016 Infectious Diseases Society of America (IDSA) criteria. Demographic data, clinical manifestations, laboratory findings, microbiological results, and in-hospital outcomes were collected and analyzed. Results: The mean age was 73 ± 2 years, and 55.3% of patients were female. Invasive mechanical ventilation was required in 65.8% of patients, while septic shock occurred in 50%. The sputum culture positivity rate was 73.7%, and blood cultures were positive in 23.7% of cases. Gram-negative bacteria predominated (92.8%), with Klebsiella spp. (60.7%) being the most common pathogen, followed by A. baumannii (17.6%), E. coli (7.2%), and Pseudomonas aeruginosa (3.6%). Gram-positive pathogens included methicillin-resistant Staphylococcus aureus (3.6%) and Streptococcus pneumoniae (3.6%). Multidrug-resistant organisms were identified in 78.6% of isolates, including multidrug-resistant (MDR) strains in 13.6% and extensively drug-resistant (XDR) strains in 86.4%, with no pandrug-resistant (PDR) isolates detected. All multidrug-resistant isolates were gram-negative bacteria. Among these, Klebsiella spp. accounted for 59%, followed by A. baumannii (22.7%), E. coli (9%), P. aeruginosa (4.5%), and Enterococcus spp. (4.5%). Klebsiella spp. demonstrated high resistance rates to most antibiotics, including amoxicillin (100%), piperacillin–tazobactam (100%), ceftriaxone (75%), ceftazidime (75%), meropenem (73.3%), imipenem (57.1%), amikacin (40%), and ciprofloxacin (84.6%), but remained susceptible to colistin. A. baumannii was resistant to all tested antibiotics and showed only intermediate susceptibility to colistin. Conclusions:  Gram-negative bacteria, particularly Klebsiella spp., were the predominant pathogens and exhibited high levels of antimicrobial resistance, with the majority classified as XDR. Resistance rates were high for most antibiotics, with colistin remaining the only consistently active agent.