目的 探討清鎮(zhèn)市第一人民醫(yī)院神經(jīng)外科患者下呼吸道標(biāo)本病原菌構(gòu)成特點及耐藥情況，為臨床合理使用抗菌藥物治療提供參考依據(jù)。方法 收集2016年1月—2021年12月清鎮(zhèn)市第一人民醫(yī)院神經(jīng)外科患者送檢的合格下呼吸道標(biāo)本，采用梅里埃VITEK 2-compact分析儀進行細菌鑒定和藥物敏感性試驗。結(jié)果 共檢出663株細菌，其中革蘭陰性桿菌有556株，占比83.9%；革蘭陽性球菌有107株，占比16.1%；常見病原菌為肺炎克雷伯菌（214株，32.3%）、鮑曼不動桿菌（93株，14.0%）、金黃色葡萄球菌（91株，13.7%）、銅綠假單胞菌（80株，12.1%）和大腸埃希菌（61株，9.2%）。耐藥性監(jiān)測結(jié)果顯示，肺炎克雷伯菌和大腸埃希菌產(chǎn)超廣譜β-內(nèi)酰胺酶（ESBLs）菌株分別占33.1%、60.6%，對碳青霉烯類藥物的耐藥率為8.9%、1.6%；鮑曼不動桿菌對氨曲南、頭孢他啶、氨芐西林/舒巴坦、環(huán)丙沙星和頭孢吡肟的耐藥率超過60.0%，對亞胺培南的耐藥率為53.8%；銅綠假單胞菌對慶大霉素、阿米卡星和妥布霉素的耐藥率低于15.0%，對亞胺培南的耐藥率為45.0%。金黃色葡萄球菌中甲氧西林耐藥金黃色葡萄球菌（MRSA）檢出率為62.6%，MRSA的耐藥率明顯高于甲氧西林敏感金黃色葡萄球菌（MSSA），未檢出對替加環(huán)素、萬古霉素和利奈唑胺耐藥的菌株。結(jié)論 清鎮(zhèn)市第一人民醫(yī)院神經(jīng)外科患者下呼吸道感染病原菌以革蘭陰性桿菌為主，肺炎克雷伯菌、鮑曼不動桿菌、金黃色葡萄球菌、銅綠假單胞菌和大腸埃希菌是常見的病原菌。病原菌對臨床常用抗菌藥物耐藥嚴重，多重耐藥細菌檢出率高，臨床用藥治療前應(yīng)及時采樣進行細菌培養(yǎng)和藥物敏感性試驗，根據(jù)藥敏試驗結(jié)果制定合理的治療方案。

Objective To investigate the pathogenic bacteria composition characteristics and drug resistance of lower respiratory tract specimens of neurosurgery patients in Qingzhen First People's Hospital, so as to provide reference for rational use of antibiotics in clinic. Methods From January 2016 to December 2021, the qualified lower respiratory tract specimens were collected, the bacteria identification and drug sensitivity test were carried out by VITEK 2-compact analyzer.Results A total of 663 strains of bacteria were detected, including 556 strains of gram-negative bacilli, accounting for 83.9%. There were 107 strains of gram-positive cocci, accounting for 16.1%. The common pathogens were Klebsiella pneumoniae (214 strains, 32.3%), Acinetobacter baumannii (93 strains, 14.0%), Staphylococcus aureus (91 strains, 13.7%), Pseudomonas aeruginosa (80 strains, 12.1%), and Escherichia coli (61 strains, 9.2%). The results of drug resistance monitoring showed that ESBLs producing strains of Klebsiella pneumoniae and Escherichia coli accounted for 33.1% and 60.6%, respectively, and the resistance rates to carbapenems were 8.9% and 1.6%, respectively. The resistance rate of Acinetobacter baumannii to aztreonam, ceftazidime, ampicillin/sulbactam, ciprofloxacin, and cefepime was more than 60.0%, and the resistance rate to imipenem was 53.8%. The resistance rate of Pseudomonas aeruginosa to gentamicin, amikacin, and tobramycin was less than 15.0%, and to imipenem was 45.0%. The detection rate of MRSA in Staphylococcus aureus was 62.6%. The drug resistance rate of MRSA was significantly higher than that of MSSA. No strains resistant to tigecycline, vancomycin, and linezolid were detected. Conclusion Gram negative bacilli are the main pathogens of lower respiratory tract infection in neurosurgery patients of Qingzhen First People's Hospital. Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli are common pathogens. The pathogenic bacteria are highly resistant to commonly used antibiotics, and the detection rate of multi drug resistant bacteria is high, drug sensitivity test should be made according to the results of drug sensitivity test.

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