无多重耐药危险医院获得性肺炎病原菌分布特点与耐药性分析

目的分析温州医科大学附属义乌医院无多重耐药危险医院获得性肺炎（HAP）病原菌分布特点及耐药性。方法人选无多药耐药危险因素的医院获得性肺炎（HAP）患者352例，按照发病时间分为早发HAP组与晚发HAP组，采集合格痰标本，进行细菌分离、鉴定和药敏试验，并分析比较患者病原菌分布特点及耐药性。结果人选的352例患者共分离m393株病原菌，HAP最常见的病原菌排名前五位的分别是为肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌及鲍曼不动杆菌，早发HAP排名前五位的分别是肺炎克雷伯杆菌、大肠埃希菌、金黄色葡萄球菌、肺炎链球菌和铜绿假单胞菌，晚发HAP排名前五位的分别是肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌和金黄色葡萄球菌，两组患者革兰阳性菌与革兰阴性菌所占比例差异无统计学意义（P〉0．05），78株革兰阳性菌对常用抗生素的耐药率早发与晚发HAP差异无统计学意义（P〉0．05），296株革兰阴性菌对常用抗生素的耐药率，早发HAP与晚发HAP除了对哌拉西林和阿莫西林克拉维酸钾的耐药率差异有统计学意义（P〈0．05），其余的差异有统计学意义（P〉0．05），但是晚发HAP中检出耐甲氧西林金葡菌（MRSA）、产ESBLs肺炎克雷伯杆菌及耐碳青霉烯鲍曼不动杆菌（CR—AB）比例增高。结论无多重耐药危险因素的医院获得性肺炎（HAP）患者，早发与晚发HAP感染病原菌差别不大，虽晚发HAP的耐药率相对较高，但对大部分抗菌素敏感，所以适当使用抗菌素，对于减轻选择抗菌药物的压力、减少耐药菌株的产生和二重感染有重要意义。

The bacteria distribution characteristics and drug resistance of no risk factory for MDR hospital-acquired pneumonia

Objective To analyze the bacteria distribution characteristics and drug resistance of no risk factory for MDR hospital-acquired pneumonia in Yiwu central hospital. Methods 352 patients with no risk factory for MDR hospital-acquired pneumonia were divided into early onset HAP group and late onset HAP group. The collection of the qualified sputum samples, bacterial isolation, identification and drug susceptibility testing were performed, and study the bacteria distribution characteristics and drug resistance. Results 393 pathogenic strains were isolated from 352 patients. Leading the first 5 places on the list of all the bacteria were Klebsiella pneumonia, Escherichia coil, Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobaeter baumannii in HAP; Leading the first 5 places on the list of all the bacteria were Klebsiella pneumonia, Escherichia eoli, Staphylococcus aureus, Streptococcus pneoumoniae and Pseudomonas aeruginosa in early onset HAP; Leading the first 5 places on the list of all the bacteria were Klebsiella pneumonia, Eseherichia eoli, Pseudomonas aeruginosa, Acinetobaeter baumannii and Staph-ylococeus aureus in late onset HAP. Both groups were no gnifieant difference in percentage of gram positive bacteria and gram-negative bacterium （P 〉 0.05 ） , 78 gram-positive bacteria strains were no significant difference of drug resistance in early onset HAP group and late onset HAP group （ P 〉 0.05 ）, 296 gram-negative bacteria strains were significant difference of resistance rates to piperacillin and amoxicillin sodium and clavulanate potassium in early onset HAP group and late onset HAP group（ P 〈 0.05 ） , there were no significant difference of drug resistance in other antibiotics （ P 〉 0.05 ）, but the ratio of methicillin-resistant Staphylococcus （ MRSA ） , ESBLs Klebsiella pneumonia and carbapenem-resistance Acinetobacter baumannii （CR-AB） were increased in late onset HAP. Conclusion The infective bacterias are no significant difference in no risk factory for MDR hospital-acquired pneumonia wether early onset HAP or late onset HAP, the resistance rate is relatively high in late onset HAP, but susceptibility to most antibiotics, so suitable use antibiotic, it can reduce stress in selection of antimicrobial agents,it can reduce the drug resistant strains and double infection.