目的 了解并分析本医院内获得性肺炎(hospital acquired pneumonia, HAP)的病原菌分布及革兰阴性杆菌耐药性。方法 收集医院2012-2016年HAP患者标本的非重复病原菌,采用MIC法进行药敏试验,参照美国临床实验室标准化委员会 (CLSI)的标准判断结果。结果 HAP以革兰阴性菌为主,在革兰阴性菌中前三位的是铜绿假单胞杆菌、肺炎克雷伯菌和鲍曼不动杆菌,所占比例分别是17.38%,17.30%,15.98%。在革兰阳性菌中,以金黄色葡萄球菌为主。在病原菌中,真菌院内获得性呼吸道感染稳定在12%~15%。铜绿假单胞菌对阿米卡星的敏感性最高,达87.76%~95.56%;肺炎克雷伯菌对美罗培南、亚胺培南敏感性呈逐年下降;鲍曼不动杆菌对阿米卡星(敏感性63.64%~84.78%)外的其他抗菌药物的敏感性均较差。结论 多重耐药的铜绿假单胞菌和鲍曼不动杆菌检出率呈现显著下降趋势,产ESBL及耐碳青霉烯类的肺炎克雷伯菌需引起高度重视,严格执行隔离措施;MRSA虽在下降,但未呈现显著下降,仍需进一步监测管理

Objective To analyze both the distribution of pathogens that cause hospital acquired pneumonia and drug resistance of gram-negative bacteria in a hospital. Methods Pathogens of hospital-acquired pneumonia were collected from 2012 to 2016. The drug resistance of gram-negative bacteria was detected with MIC and evaluated according to the criteria of Clinical and Laboratory Standard Institute of America (CLSI). Results Among these pathogens of hospital-acquired pneumonia, gram-negative bacteria were common and the top three organisms were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Baumanii, accounting for 17.38%, 17.30%, and 15.98%, respectively. Among gram-positive bacteria, Staphylococcys aureus was common. In these pathogens, fungus accounted for 12% to 15% of acquired respiratory tract infections.Pseudomonas aeruginosa was the most sensitive to amikacin (87.76%-95.56%). The sensitivity of Klebsiella pneumoniae to meropenem and imipenem decreased year by year.The sensitivity of Baumanii to other antimicrobial agents was low except amikacin (63.64%-84.78%). Conclusions The detection rate of multi-drug resistance of Pseudomonas aeruginosa and Baumanii is beginning to decrease significantly. Klebsiella pneumoniae, which produces ESBL and carbon-resistant penicillium, is worthy of attention. Regular and prudent surveillance of the distribution of pathogens responsible for hospital acquired pneumonia and drug resistance can help clinicians to treat and prevent HAP.