Objectve To analyze both the distribution of pathogens that cause hospital acquired pneumonia and drug resistance of gram-negative bacteria in a hospital.Methods Pathogens of hospital-acquired pneumonia were collected from 2012 to 2016.The drug resistance of gram-negative bacteria was detected with MIC and evaluated according to the criteria of Clinical and Laboratory Standard Institute of America (CLSI).Results Among these pathogens of hospital-acquired pneumonia,gram-negative bacteria were common and the top three organisms were Pseudomonas aeruginosa,Klebsiella pneumoniae,and Baumanii,accounting for 17.38％,17.30％,and 15.98％,respectively.Among gram-positive bacteria,Staphylococcys aureus was common.In these pathogens,fungus accounted for 12％ to 15％ of acquired respiratory tract infections.Pseudomonas aeruginosa was the most sensitive to amikacin (87.76％-95.56％).The sensitivity of Klebsiella pneumoniae to meropenem and imipenem decreased year by year.The sensitivity of Baumanii to other antimicrobial agents was low except amikacin (63.64％-84.78％).Conclusions The detection rate of multi-drug resistance of Pseudomonas aeruginosa and Baumanii is beginning to decrease significantly.Klebsiella pneumoniae,which produces ESBL and carbon-resistant penicillium,is worthy of attention.Regular and prudent surveillance of the distribution of pathogens responsible for hospital acquired pneumonia and drug resistance can help clinicians to treat and prevent HAP.%目的 了解并分析本医院内获得性肺炎(hospital acquired pneumonia,HAP)的病原菌分布及革兰阴性杆菌耐药性.方法 收集医院2012-2016年HAP患者标本的非重复病原菌,采用MIC法进行药敏试验,参照美国临床实验室标准化委员会(CLSI)的标准判断结果.结果 HAP以革兰阴性菌为主,在革兰阴性菌中前三位的是铜绿假单胞杆菌、肺炎克雷伯菌和鲍曼不动杆菌,所占比例分别是17.38％,17.30％,15.98％.在革兰阳性菌中,以金黄色葡萄球菌为主.在病原菌中,真菌院内获得性呼吸道感染稳定在12％～15％.铜绿假单胞菌对阿米卡星的敏感性最高,达87.76％～ 95.56％;肺炎克雷伯菌对美罗培南、亚胺培南敏感性呈逐年下降;鲍曼不动杆菌对阿米卡星(敏感性63.64％～ 84.78％)外的其他抗菌药物的敏感性均较差.结论 多重耐药的铜绿假单胞菌和鲍曼不动杆菌检出率呈现显著下降趋势,产ESBL及耐碳青霉烯类的肺炎克雷伯菌需引起高度重视,严格执行隔离措施;MRSA虽在下降,但未呈现显著下降,仍需进一步监测管理
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