2016—2021年清镇市第一人民医院神经外科患者下呼吸道标本病原菌分布特征及耐药性分析

目的 探讨清镇市第一人民医院神经外科患者下呼吸道标本病原菌构成特点及耐药情况，为临床合理使用抗菌药物治疗提供参考依据。方法 收集2016年1月—2021年12月清镇市第一人民医院神经外科患者送检的合格下呼吸道标本，采用梅里埃VITEK 2-compact分析仪进行细菌鉴定和药物敏感性试验。结果 共检出663株细菌，其中革兰阴性杆菌有556株，占比83.9%；革兰阳性球菌有107株，占比16.1%；常见病原菌为肺炎克雷伯菌（214株，32.3%）、鲍曼不动杆菌（93株，14.0%）、金黄色葡萄球菌（91株，13.7%）、铜绿假单胞菌（80株，12.1%）和大肠埃希菌（61株，9.2%）。耐药性监测结果显示，肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶（ESBLs）菌株分别占33.1%、60.6%，对碳青霉烯类药物的耐药率为8.9%、1.6%；鲍曼不动杆菌对氨曲南、头孢他啶、氨苄西林/舒巴坦、环丙沙星和头孢吡肟的耐药率超过60.0%，对亚胺培南的耐药率为53.8%；铜绿假单胞菌对庆大霉素、阿米卡星和妥布霉素的耐药率低于15.0%，对亚胺培南的耐药率为45.0%。金黄色葡萄球菌中甲氧西林耐药金黄色葡萄球菌（MRSA）检出率为62.6%，MRSA的耐药率明显高于甲氧西林敏感金黄色葡萄球菌（MSSA），未检出对替加环素、万古霉素和利奈唑胺耐药的菌株。结论 清镇市第一人民医院神经外科患者下呼吸道感染病原菌以革兰阴性杆菌为主，肺炎克雷伯菌、鲍曼不动杆菌、金黄色葡萄球菌、铜绿假单胞菌和大肠埃希菌是常见的病原菌。病原菌对临床常用抗菌药物耐药严重，多重耐药细菌检出率高，临床用药治疗前应及时采样进行细菌培养和药物敏感性试验，根据药敏试验结果制定合理的治疗方案。

Distribution characteristics and drug resistance of pathogens from lower respiratory tract specimens of neurosurgery patients in Qingzhen First People's Hospital from 2016 to 2021

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.