摘要：
目的 分析院内获得性肺炎(HAP)多重耐药菌感染的流行特征及耐药情况.方法 选取2016年3月至2018年3月期间本院收治的HAP多重耐药菌感染患者436例,回顾性分析患者的临床资料,细菌培养患者的呼吸道分泌物和晨痰标本,确定HAP多重耐药菌感染的流行特征及耐药情况.结果 调查的436例院内获得性肺炎患者,年龄段以60岁以上(38.99％)和40～59岁之间(34.86％)为主,分布的科室前3位分别为重症监护室(ICU,19.04％)、呼吸内科(15.37％)和泌尿外科(13.76％).临床变量中占比最多的分别为机械通气(71.79％),一个月内使用过2类以上抗感染药物(65.99％)和留置导尿管(46.79％).共分离得到479株多重耐药菌,前5位分别为甲氧西林耐药金黄色葡萄球菌(MRSA,35.91％),甲氧西林耐药凝固酶阴性葡萄球菌(MRSCON,24.63％),产超广谱β-内酰胺酶(ESBLs)的大肠埃希菌(15.03％),产ESBLs的肺炎克雷伯菌(8.98％),铜绿假单胞菌(6.47％).多重耐药菌在ICU(21.50％)、呼吸内科(14.61％)和泌尿外科(13.57％)科室感染分布最多.革兰氏阳性菌中除MRSA和MRSON仅对万古霉素敏感,肠球菌对氯霉素和万古霉素敏感外,对其他抗菌药物均有一定的耐药性;革兰氏阴性菌中除大肠杆菌和肺炎克雷伯菌对亚胺培南敏感,铜绿假单胞菌和鲍曼不动杆菌对米诺环素敏感外,均对其他抗菌药物有不同程度的耐药性.结论 针对调研分析得到的HAP多重耐药菌感染的流性特征,医院应加强多重耐药菌的感染防控工作,特别是针对高危科室和易感人群制定相关措施.同时临床医师因根据多重耐药菌的耐药情况结果,合理使用抗生素,降低感染的发生.%Objective To analyze the epidemiological characteristics and drug resistance of multidrug-resistant bacterial infection in hospital acquired pneumonia (HAP).Methods 436 patients with HAP multi-drug-resistant bacterial infection admitted to our hospital from March 2016 to March 2018 were selected.The clinical data,respiratory secretions,and morning sputum samples of patients with HAP multi-drug-resistant bacterial infection were retrospectively analyzed to determine the epidemiological characteristics and drug resistance of HAP multi-drug-resistant bacterial infection.Results In 436 cases of hospital acquired pneumonia,the main age groups were over 60 years old (38.99％) and between 40 and 59 years old (34.86％);the top three departments were intensive care unit (ICU,19.04％),respiratory medicine department (15.37％),and urology department (13.76％);the most common clinical variables were mechanical ventilation (71.79％),usage of more than two kinds of anti-infective drugs within one month (65.99％),and indwelling catheter (46.79％).479 strains of multidrug-resistant bacteria were isolated.The first five strains were methicillin-resistant staphylococcus aureus (MRSA,35.91％),methicillin-resistant coagulase-negative staphylococcus (MRSCON,24.63％),escherichia coli producing extended spectrum beta lactamases (ESBLs) (15.03％),klebsiella pneumoniae producing ESBLs (8.98％),and pseudomonas aeruginosa (6.47％).Multidrug-resistant bacteria were most commonly found in ICU (21.50％),respiratory medicine (14.61％),and urology (13.57％).The Gram-positive bacteria were resistant to other antibiotics,except MRSA and MRSON were sensitive to vancomycin,enterococci was sensitive to chloramphenicol and vancomycin.Gram-negative bacteria were resistant to other antimicrobial agents to varying degrees,except escherichia coli and klebsiella pneumoniae were sensitive to imipenem,pseudomonas aeruginosa and acinetobacter bauman were sensitive to minocycline.Conclusions In view of the fluidity of HAP multi-drug-resistant bacterial infection,hospitals should strengthen the prevention and control of infection of multi-drug-resistant bacteria,especially for high-risk departments and susceptible populations.At the same time,clinicians should rationally use antibiotics to reduce the incidence of infection according to the results of drug resistance of multi-drug resistant bacteria.
