目的 探究2017—2019年天津市第五中心醫(yī)院重癥肺炎患者病原菌分布及耐藥性。方法 選取2017年1月至2019年12月于天津市第五中心醫(yī)院急診監(jiān)護室及重癥醫(yī)學科就診的重癥肺炎病例198例為研究對象，收集患者住院時臨床資料，采集患者包括痰液、支氣管分泌物、肺泡灌洗液等下呼吸道標本進行病原菌的分離和鑒定，使用K-B試紙擴散法對檢出的病原菌進行藥敏試驗探究病原菌的耐藥性。結(jié)果 198例重癥肺炎患者共送檢下呼吸道樣本1 690份，其中包括890份支氣管分泌物、715份痰液、64份肺泡灌洗液以及11份支氣管刷檢物。共分離出病原菌544株，病原菌檢出率為32.19%。檢測出的病原菌中以革蘭陰性菌最多，共470株，占比86.40%，主要包括鮑曼不動桿菌、肺炎克雷伯菌以及銅綠假單胞菌；革蘭陽性菌共37株，占比6.80%，主要以金黃色葡萄球菌為主；真菌共37株，占比6.80%，主要以白假絲酵母菌為主。藥敏試驗顯示，革蘭陰性菌中鮑曼不動桿菌對復方新諾明、頭孢哌酮敏感性較高，肺炎克雷伯菌對亞胺培南和阿卡米星敏感性較高，銅綠假單胞菌對阿米卡星、喹諾酮以及妥布霉素敏感性較高；革蘭陽性菌中金黃色葡萄球菌對第三代頭孢、復方新諾明以及喹諾酮敏感性較高。革蘭陰性菌和革蘭陽性菌對其他抗生素敏感性均不明顯，耐藥性較強。結(jié)論 2017—2019年天津市第五中心醫(yī)院重癥肺炎患者病原菌以革蘭陰性菌為主，其中以鮑曼不動桿菌最為常見，革蘭陽性菌中以金黃色葡萄球菌為主，重癥肺炎患者病原菌對多數(shù)臨床常用的抗生素表現(xiàn)出較高的耐藥性。

Objective To explore the distribution and drug resistance of pathogens in patients with severe pneumonia in the Fifth Central Hospital of Tianjin from 2017 to 2019. Methods 198 Patients with severe pneumonia treated at the Fifth Central Hospital Hospital in Tianjin from January 2017 to December 2019 were collected. The clinical data on patients' hospitalization were collected. Sputum, bronchial secretions, alveoopyl irrigation and other lower respiratory samples of patients were collected for separation and identification of pathogens, and K-B test paper diffusion method was used to detect drug-sensitive test for pathogen drug-resistance. Results A total of 1 690 respiratory samples from 198 patients with severe pneumonia were detected, including 890 bronchial secretions, 715 sputum, 64 alveolar irrigation and 11 bronchial brush samples. A total of 544 strains of pathogens were isolated, and the detection rate of pathogens was 32.19%. Among the detected pathogens, the gram-negative bacteria were the most, with a total of 470 strains, accounting for 86.40%, mainly including Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. There were 37 gram-positive bacteria, accounting for 6.80%, mainly Staphylococcus aureus. There were 37 strains of fungi, accounting for 6.80%, mainly Candida albicans. The drug sensitivity test showed that among Gram-negative bacteria, Acinetobacter baumannii was more sensitive to trimoxazole and cefoperazone, Klebsiella pneumoniae was more sensitive to imipenem and acamicin, and Pseudomonas aeruginosa was more sensitive to amikacin, quinolone and tobramycin. Among Gram-positive bacteria, Staphylococcus aureus was highly sensitive to tri-generation cephalosporin, compound neomine and quinolone. The sensitivity of gram-negative bacteria and gram-positive bacteria to other antibiotics was not obvious and the drug resistance was strong. Conclusion Gram-negative bacteria were the main pathogens of severe pneumonia patients in the Fifth Central Hospital of Tianjin from 2017 to 2019, among which Acinetobacter baumannii was the most common. Among Gram-positive bacteria, Staphylococcus aureus was the main pathogen. The pathogens of severe pneumonia patients showed high resistance to most commonly used antibiotics.

R978.1