目的 探究2017—2019年天津市第五中心医院重症肺炎患者病原菌分布及耐药性。方法 选取2017年1月至2019年12月于天津市第五中心医院急诊监护室及重症医学科就诊的重症肺炎病例198例为研究对象，收集患者住院时临床资料，采集患者包括痰液、支气管分泌物、肺泡灌洗液等下呼吸道标本进行病原菌的分离和鉴定，使用K-B试纸扩散法对检出的病原菌进行药敏试验探究病原菌的耐药性。结果 198例重症肺炎患者共送检下呼吸道样本1 690份，其中包括890份支气管分泌物、715份痰液、64份肺泡灌洗液以及11份支气管刷检物。共分离出病原菌544株，病原菌检出率为32.19%。检测出的病原菌中以革兰阴性菌最多，共470株，占比86.40%，主要包括鲍曼不动杆菌、肺炎克雷伯菌以及铜绿假单胞菌；革兰阳性菌共37株，占比6.80%，主要以金黄色葡萄球菌为主；真菌共37株，占比6.80%，主要以白假丝酵母菌为主。药敏试验显示，革兰阴性菌中鲍曼不动杆菌对复方新诺明、头孢哌酮敏感性较高，肺炎克雷伯菌对亚胺培南和阿卡米星敏感性较高，铜绿假单胞菌对阿米卡星、喹诺酮以及妥布霉素敏感性较高；革兰阳性菌中金黄色葡萄球菌对第三代头孢、复方新诺明以及喹诺酮敏感性较高。革兰阴性菌和革兰阳性菌对其他抗生素敏感性均不明显，耐药性较强。结论 2017—2019年天津市第五中心医院重症肺炎患者病原菌以革兰阴性菌为主，其中以鲍曼不动杆菌最为常见，革兰阳性菌中以金黄色葡萄球菌为主，重症肺炎患者病原菌对多数临床常用的抗生素表现出较高的耐药性。

Objective To explore the distribution and drug resistance of pathogens in patients with severe pneumonia in the Fifth Central Hospital of Tianjin from 2017 to 2019. Methods 198 Patients with severe pneumonia treated at the Fifth Central Hospital Hospital in Tianjin from January 2017 to December 2019 were collected. The clinical data on patients' hospitalization were collected. Sputum, bronchial secretions, alveoopyl irrigation and other lower respiratory samples of patients were collected for separation and identification of pathogens, and K-B test paper diffusion method was used to detect drug-sensitive test for pathogen drug-resistance. Results A total of 1 690 respiratory samples from 198 patients with severe pneumonia were detected, including 890 bronchial secretions, 715 sputum, 64 alveolar irrigation and 11 bronchial brush samples. A total of 544 strains of pathogens were isolated, and the detection rate of pathogens was 32.19%. Among the detected pathogens, the gram-negative bacteria were the most, with a total of 470 strains, accounting for 86.40%, mainly including Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. There were 37 gram-positive bacteria, accounting for 6.80%, mainly Staphylococcus aureus. There were 37 strains of fungi, accounting for 6.80%, mainly Candida albicans. The drug sensitivity test showed that among Gram-negative bacteria, Acinetobacter baumannii was more sensitive to trimoxazole and cefoperazone, Klebsiella pneumoniae was more sensitive to imipenem and acamicin, and Pseudomonas aeruginosa was more sensitive to amikacin, quinolone and tobramycin. Among Gram-positive bacteria, Staphylococcus aureus was highly sensitive to tri-generation cephalosporin, compound neomine and quinolone. The sensitivity of gram-negative bacteria and gram-positive bacteria to other antibiotics was not obvious and the drug resistance was strong. Conclusion Gram-negative bacteria were the main pathogens of severe pneumonia patients in the Fifth Central Hospital of Tianjin from 2017 to 2019, among which Acinetobacter baumannii was the most common. Among Gram-positive bacteria, Staphylococcus aureus was the main pathogen. The pathogens of severe pneumonia patients showed high resistance to most commonly used antibiotics.

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