5 155株医院获得性肺炎致病菌分布和抗菌素敏感性分析

目的分析空军军医大学唐都医院医院获得性肺炎(hospital acquired pneumonia, HAP)致病菌分布及药敏试验结果，为经验性治疗HAP提供依据。 方法收集2017年01月至2019年12月我院临床送检呼吸道标本细菌培养结果、药敏试验结果。 结果共筛选合格菌株5 155株，其中鲍曼不动杆菌最多(26.7%)，其次为铜绿假单胞菌(19.6%)、肺炎克雷伯菌(14.4%)等。除了多粘菌素和替加环素，鲍曼不动杆菌对头孢哌酮舒巴坦(76.12%)表现出较高的敏感度，其他抗菌素敏感度多低于20%，其中多重耐药、广泛耐药、耐碳青酶烯类鲍曼不动杆菌检出率分别为78.49%、12.28%、84.81%。铜绿假单胞菌对阿米卡星敏感度较高，达86.26%，亚胺培南、美罗培南敏感度较差，约60%，多重耐药、广泛耐药、耐碳青酶烯类铜绿假单胞菌检出率分别为34.42%、3.46%、38.18%。耐碳青酶烯类肠杆菌科细菌检出率为11.67%。未发现对万古霉素、利奈唑胺耐药的金黄色葡萄球菌和肺炎链球菌，耐甲氧西林金黄色葡萄球菌检出率为46.03%。 结论HAP致病菌耐药形势严峻，应引起临床足够重视，加强细菌耐药监测可有效指导临床合理用药。

Analysis of the distribution and drug susceptibility of 5 155 strains of pathogenic bacteria of hospital-acquired pneumonia

ObjectiveTo analyze the distribution and drug susceptibility of pathogenic bacteria of hospital acquired pneumonia (HAP) in Tang Du Hospital of Air Force Military Medical University, so as to provide reference for the empirical treatment of HAP. MethodsBacterial culture results and drug susceptibility results of clinical respiratory specimens were collected retrospectively from January, 2017 to December, 2019 in our hospital. ResultsA total of 5155 qualified strains were collected and screened, Acinetobacter baumannii accounted for the most (26.7%), followed by Pseudomonas aeruginosa (19.6%) and klebsiella pneumoniae (14.4%) and so on. In addition to polycolistin and tegacycline, Acinetobacter baumannii showed high sensitivity to cefoperazone-sulbactan (76.12%), while most antibiotics less than 20%. Among them, the detection rates of multi-drug resistant, extensively drug resistant and carbapenem-resistant Acinetobacter baumannii were 78.49%, 12.28% and 84.81%, respectively. The sensitivity of Pseudomonas aeruginosa to amikacin was high up to 86.26%, and that of imipenem and meropenem was lower, about 60%. the detection rates of multi-drug resistant, extensively drug resistant and carbapenem-resistant Pseudomonas aeruginosa were 34.42%, 3.46% and 38.18%, respectively. The detection rate of carbapenem-resistant Enterobacteriaceae was 11.67%, No strains resistant to vancomycin or linezolid were found in Staphylococcus aureus and Streptococcus pneumoniae. The detection of Methicillin-resistant Staphylococcus aureus were 46.03%. ConclusionThe situation of drug resistance of HAP pathogens is severe, which should be paid enough attention in clinical practice. Strengthening bacterial drug resistance monitoring can effectively guide clinical rational drug use.