Objective To analyze the drug resistance of hospital acquired pneumonia caused by non-fermentative gram negative bacilli(NFGNB)and the risk factors.Methods From March 2013 to March 2016,a total of 61 patients with hospital acquired pneumonia caused by NFGNB were selected as observation group in the Department of Respiratory,the Second Affiliated Hospital of Hainan Medical University,meanwhile a total of 190 healthy adults admitted to this hospital for physical examination were selected as control group.Subjects of the two groups received pathogenic identification and drug sensitivity test,and their clinical data was collected,risk factors of hospital acquired pneumonia caused by NFGNB were analyzed by multivariate Logistic regression analysis.Results A total of 72 strains of NFGNB were separated from the 61 patients,including 41 strains of acinetobacter baumannii(accounting for 56.9%),27 strains of pseudomonas aeruginosa(accounting for 37.5%), 3 strains of stenotrophomonas maltophilia(accounting for 4.2%),1 strain of chryseobacterium indologenes(accounting for 1.4%).The antibiotic sensitive rate of acinetobacter baumannii to meropenem was 75.6%,while the drug resistance rates of acinetobacter baumannii to cefuroxime,cefmetazole,ertapenem,gentamicin and ciprofloxacin were all over 80.0%.The antibiotic sensitive rates of pseudomonas aeruginosa to piperacillin/tazobactam and meropenem were all over 80.0%,while the drug resistance rate of pseudomonas aeruginosa to ceftazidime and gentamicin was 37.0% and 44.4%,respectively.No statistically significant differences of age,gender,incidence of diabetes,proportion of patients received endotracheal intubation,tracheotomy or enteral nutrition,proportion of patients used antifungal agents,proportion of patients received two or over antibiotics was found between the two groups(P>0.05);proportion of patients with APACHEⅡ score equal or over 20,with hospital stays equal or over 14 days,with ICU stays equal or over 7 days,with duration of mechanical ventilation equal or over 7 days,with antibiotics consumption equal or over 14 days was statistically significantly higher than that of control group,respectively(P<0.05).Multivariate Logistic regression analysis results showed that,APACHEⅡ score equal or over 20〔OR=3.357,95%CI(2.014,4.667)〕,duration of mechanical ventilation equal or over 7 days〔OR=1.933,95%CI(1.106,3.781)〕and antibiotics consumption equal or over 14 days〔OR=1.685,95%CI(1.087,3.099)〕were independent risk factors of hospital acquired pneumonia caused by NFGNB(P<0.05).Conclusion Acinetobacter baumannii and pseudomonas aeruginosa are the major pathogenic bacteria,meanwhile drug resistance rate of acinetobacter baumannii is relatively high;APACHEⅡ score equal or over 20,duration of mechanical ventilation equal or over 7 days and antibiotics consumption equal or over 14 days are independent risk factors of hospital acquired pneumonia caused by NFGNB.%目的 分析非发酵革兰阴性杆菌(NFGNB)所致院内获得性肺炎的耐药性及其危险因素.方法 选取2013年3月-2016年3月海南医学院第二附属医院呼吸科收治的NFGNB所致院内获得性肺炎患者61例作为观察组,另选取同期健康体检者190例作为对照组.两组受试者均行病原菌鉴定及药敏试验,收集其病历资料,NFGNB所致院内获得性肺炎的危险因素分析采用多因素Logistic回归分析.结果 61例患者共分离出NFGNB 72株,其中鲍曼不动杆菌41株(占56.9%),铜绿假单胞菌27株(占37.5%)、嗜麦芽窄食单胞菌3株(占4.2%)、产吲哚金黄杆菌1株(占1.4%).鲍曼不动杆菌对美罗培南的敏感率较高,为75.6%;对头孢呋辛、头孢美唑、厄他培南、庆大霉素及环丙沙星的耐药率较高,均高于80.0%.铜绿假单胞菌对哌拉西林/他唑巴坦和美罗培南的敏感率较高,均高于80.0%;对头孢他啶和庆大霉素的耐药率较高,分别为37.0%、44.4%.两组受试者年龄、性别、糖尿病发生率、气管插管率、气管切开率、肠内营养者所占比例、使用抗真菌药物者所占66例、抗生素使用种类≥2种者所占比例比较,差异无统计学意义(P>0.05);观察组患者急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分≥20分、住院时间≥14 d、ICU入住时间≥7 d、机械通气时间≥7 d及抗生素使用时间≥14 d者所占比例高于对照组,差异有统计学意义(P<0.05).多因素Logistic回归分析结果显示,APACHEⅡ评分≥20分〔OR=3.357,95%CI(2.014,4.667)〕、机械通气时间≥7 d〔OR=1.933,95%CI(1.106,3.781)〕及抗生素使用时间≥14 d〔OR=1.685,95%CI(1.087,3.099)〕是NFGNB所致院内获得性肺炎的独立危险因素(P<0.05).结论 NFGNB所致院内获得性肺炎患者病原菌以鲍曼不动杆菌和铜绿假单胞菌为主,其中鲍曼不动杆耐药率较高;APACHEⅡ评分≥20分、机械通气时间≥7 d和抗生素使用时间≥14 d是NFGNB所致院内获得性肺炎的危险因素.
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