分析获得性肺炎患者血流感染病原菌分布及耐药性。

选取2017年3月至2021年7月北京积水潭医院收治的305例医院获得性肺炎患者为对象，采集年龄、性别、住院时间、合并基础疾病、气管插管例数、原发感染灶、血培养及药敏试验结果。

305例获得性肺炎患者中并发血流感染174例(57.05%)，分离出186株病原菌，其中G^－ 137株(73.66%)，G^－中肺炎克雷伯菌32例(17.20%)，鲍曼不动杆菌29例(15.59%)、铜绿假单胞菌24例(12.90%)；G⁺ 46株(24.73%)，其中金黄色葡萄球菌19例(10.22%)；真菌3株(1.61%)。肺炎克雷伯菌对头孢曲松、氨苄西林耐药性高，对氨曲南、妥布霉素耐药性低；鲍曼不动杆菌对头孢曲松、呋喃妥因耐药性高，对氨曲南、庆大霉素耐药性低；铜绿假单胞菌对氨苄西林、呋喃妥因耐药性高，对丁胺卡那霉素、复方新诺明、氨曲南耐药性低。金黄色葡萄球菌对青霉素G、红霉素耐药性高，对万古霉素、替考拉宁耐药性低；肺炎链球菌对青霉素G、红霉素、庆大霉素耐药性高，对万古霉素、替考拉宁耐药性低。

获得性肺炎患者血流感染病原菌分布以G^－多见，其中肺炎克雷伯菌、鲍曼不动杆菌感染常见，对氨苄西林、呋喃妥因及头孢耐药性高；G⁺感染中金黄色葡萄球菌常见，对阿奇霉素、红霉素、青霉素耐药性高。

To explore the distribution of pathogenic bacteria in the bloodstream of 305 patients with acquired pneumonia and analysis of their drug resistance.

A total of 305 hospital-acquired pneumonia patients in our hospital from March 2019 to July 2020 were selected as the research subjects. The age, gender, length of stay, combined underlying diseases, proton pump inhibitor treatment and tracheal intubation cases, and primary disease were selected. Information on the site of infection, blood culture, and drug susceptibility test results were collected.

Among the 305 patients with acquired pneumonia, 174 had complicated bloodstream infections, accounting for 57.05%. A total of 186 pathogenic bacteria were isolated, of which 137 were G^-, accounting for 73.66%. Klebsiella pneumoniae was the most among G^-. It accounted for 17.20%, followed by Acinetobacter baumannii and Pseudomonas aeruginosa, accounting for 15.59% and 12.90% respectively. 46 strains of G⁺ , accounting for 24.73%, the most G⁺ Staphylococcus aureus, accounting for 10.22%. 3 strains of fungi, accounting for 1.61%. The drug susceptibility results of this study showed that Klebsiella pneumoniae had high resistance to ceftriaxone and ampicillin, but low resistance to aztreonam and tobramycin. Acinetobacter baumannii has high resistance to ceftriaxone and nitrofurantoin, but low resistance to aztreonam and gentamicin. Pseudomonas aeruginosa has high resistance to ampicillin and nitrofurantoin, but low resistance to amikacin, compound trimethoprim and aztreonam. Staphylococcus aureus has high resistance to penicillin G and erythromycin, but low resistance to vancomycin and teicoplanin. Streptococcus pneumoniae has high resistance to penicillin G, erythromycin, and gentamicin, but low resistance to vancomycin and teicoplanin.

The distribution of pathogenic bacteria in the bloodstream of patients with acquired pneumonia is mainly G^-. Among them, Klebsiella pneumoniae and Acinetobacter baumannii infection are more common, and they are highly resistant to ampicillin, nitrofurantoin and cephalosporins. Staphylococcus aureus is more common in G⁺ infections, and it is highly resistant to azithromycin, erythromycin and penicillin drugs.