中文摘要：

目的了解我院医院获得性肺炎（HAP）感染标本的病原菌分布状况及耐药特征,指导临床治疗。方法按1999年我国HAP诊治指南诊断标准,监测我院2008年1月—2010年1月住院的175例HAP患者,收集患者的临床资料（既往抗菌药物使用史,HAP发生时间等）、呼吸道分泌物及晨痰标本送细菌培养,确定HAP患者病原菌分布及耐药情况。结果呼吸道分泌物细菌培养阳性的HAP患者79例,其中早发HAP患者23例;晚发HAP患者56例。发生HAP前应用过广谱抗菌药物的占86.1%（68/79）。79例患者呼吸道分泌物共检出病原菌106株,其中革兰阳性菌38株,革兰阴性菌68株,常见的前5位致病菌分别是大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯杆菌和不动杆菌。早发HAP以革兰阳性菌为主,占63.0%（17/27）,晚发HAP患者革兰阴性菌比例明显上升达73.4%（58/79）。结论我院HAP患者多为合并多种基础疾病的老年患者,大多数在发生HAP前应用过广谱抗菌药物。早发HAP患者以革兰阳性菌为主,晚发HAP患者革兰阴性菌所占比例明显上升,并且随着住院时间的延长,非发酵菌及耐药菌比例增高。

英文摘要：

Objective To understand pathogen distribution and drug resistance of infection spectmen in hospital-acquired Pneumonia（HAP） in our hospital so as to direct clinical treatment.Methods Totally 175 inpatients with HAP indentified from January 2008 to January 2010 according to the criteria of diagnosis and treatment for HAP in China-1999.They clinical data including history of antibiotic application and the time of HAP onset were record,and the samples of their respiratory tract secretion and morning sputum were cultured so as to determine the pathogen distribution and drug resistance.Results There were 79 HAP patients whose respiratory tract secretion was positive results of bacterial culture,including 23 cases of early onset and 56 cases of late onset.The antibiotic application rate before onset of HAP accounted for 86.1%（68/79）.Among the 79 cases 106 strains were isolated from respiratory secretions,of which 38 strains were Gram-positive bacteria and 68 were Gram-negative bacteria.The first five common bacteria were Escherichia Coli,Pseudomonas aerugmosa,staphylococcus aureus,Klebsiella pneumonia and Acinetobacter baumanii.The Gram-positive bacteria were found mainly in early onset HAP,accounting for 63.0%（17/27）,while Gram-negative bacteria were found mainly in late onset HAP,accounting for 73.4%.Conclusion Most of the patients were old and with several underlying diseases,and majority of them had prior broad-spectrum antibiotics exposure.The early-onset of HAP was commonly caused by Gram-positive bacteria,while the late-onset of HAP was mainly caused by Gram-negative bacteria.The percentage of non-zymophytes and drug-resistant bacteria is increasing along with the prolonged time of hospitalization period.