174例医院获得性肺炎患者病原学特点及耐药性分析

喻昌利安庆丽郭霞李琳郭海侠李球兵梁立杰

(华北理工大学附属医院呼吸科河北唐山063000)

[摘要]①目的了解医院获得性肺炎(HAP)感染病原菌分类及耐药的特点，指导临床上合理使用抗菌药物。②方法对我院174例医院获得性肺炎患者痰培养病原菌及其药敏结果进行回顾性分析。③结果共培养出细菌185株，真菌4株。细菌以革兰阴性菌为主，占97.88%。排名前3位的分别为鲍曼不动杆菌、肺炎克雷伯肺炎亚种、铜绿假单胞菌。鲍曼不动杆菌为多重耐药菌，但对多粘菌素均敏感；肺炎克雷伯菌较为敏感的药物为碳青霉烯类及阿米卡星；铜绿假单胞菌对三、四代头孢菌素、碳青霉烯类等抗菌素较为敏感。④结论医院获得性肺炎感染病原菌以革兰阴性菌为主，呈多重耐药，应及时掌握医院获得性肺炎的常见病原菌及药敏情况，为临床合理选用抗菌药物提供理论指导。

[关键词]医院获得性肺炎病原菌药敏试验

[中图分类号]R 56[文献标识码]A

【基金项目】河北省科技计划项目(编号：152277709D)。

Distribution and antibiotics resistans of 174 Cases with hospital acquired pneumoniaYUChangli，ANQingli，GUOXia,etal(DepartmentofRespiratoryMedicine，NorthChinaUniversityofScienceandTechnology)

ABSTRACT[]ObjectiveTo learn the kinds and the characteristic of antibiotics resistance of hospital-acquired pneumonia(HAP)and direct the clinical application of antibiotics reasonably．MethodsTo analyze the pathogens and antibiotics resistance of HAP of 174 cases retrospectively．ResultsUsing sputum samples，185 strains bacteria and 4 strains of fungi were isolated．The Gram-negative bacteria were common (97.88%)，of which the first three commonest organisms were Baumannii，Klebsiella pneumoniae，Pseudomonas aeruginos．Susceptibility test demonstrated that the Baumannii was multiple resistant，both of them were susceptibility to the polymyxinthird．Klebsiella pneumoniae were susceptibility to the carbapenems and the amikacin．Pseudomonas aeruginos were susceptibility to the third and forth generation of cephalosporin，the carbapenems and so on．ConclusionGram-negative bacteria with multi-drug resistance were the commonest organism causing hospital acquired pneumonia．To provide theoretical guidance for clinical reasonable selection of antimicrobial agents，We should study timely master the characteristics and drug resistance of the pathogens．

[KEYWORDS]Hospital acquired pneumonia.Pathogenic bacteria.Susceptibility test

医院获得性肺炎(Hospital acquired pneumonia，HAP)是指患者入院时不存在、也不处于感染潜伏期，而于入院48h后在医院(包括老年护理院、康复院等)内发生的肺炎。HAP在所有常见医院感染性疾病中排名第二位[1]。HAP病死率较高，在痰培养结果回报之前有效的抗生素应用能提高初始治疗效果，降低患者死亡率；相反广谱抗菌药物的不合理使用或滥用，可导致各种耐药菌产生。本研究对2014年1月～2015年6月年我院174例获得性肺炎病例病原学特点及耐药性进行分析总结，为临床合理用药提供理论依据。……