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目的 了解北京积水潭医院下呼吸道感染住院患者病原菌分布及其耐药性.方法 选取2013-2016年北京积水潭医院呼吸与危重症医学科收治的下呼吸道感染患者痰培养或支气管分泌物培养的病原菌共2 016株,对其菌株分类及药敏结果进行回顾性分析.结果 2 016株病原菌中,革兰阴性菌1 873株(92.9％),主要为鲍曼不动杆菌(361株,17.9％)、铜绿假单胞菌(328株,16.3％)、肺炎克雷伯菌(269株,13.3％)、嗜麦芽窄食单胞菌(172株,8.5％)、阴沟肠杆菌(157株,7.8％)、大肠埃希菌(117株,5.8％);革兰阳性菌143株(7.1％),主要为金黄色葡萄球菌(29株,1.4％)和溶血性葡萄球菌(18株,0.9％).药敏结果提示,4年间大肠埃希菌及肺炎克雷伯菌对碳青霉烯类、阿米卡星的耐药率最低,均在4％以下.4年间产ESBLs肠杆菌主要以大肠埃希菌为主(43.6％),产ESBLs肺炎克雷伯菌检出率逐年升高.铜绿假单胞菌耐药率前3位分别为氨曲南、亚胺培南、头孢吡肟.鲍曼不动杆菌对多种抗菌药物耐药,其中广泛耐药鲍曼不动杆菌为49.9％.革兰阳性菌中耐药葡萄球菌属均为耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林溶血性葡萄球菌(MRSH),未见万古霉素耐药株.结论 下呼吸道感染病原菌以革兰阴性杆菌为主,主要病原菌对临床常用抗菌药物耐药率较高,临床应合理规范使用抗菌药物.“,”Objective To investigate the distribution of pathogenic bacteria and drug resistance isolated from inpatients with lower respiratory tract infection in Beijing Jishuitan Hospital.Methods A total of 2 016 sputum or bronchial secretions in the patients with lower respiratory tract infection were engaged from 2013 to 2016,and the results were analyzed retrospectively.Results A total of 2 016 strains of pathogenic bacteria were isolated,and 1 873 strains were gram-negative bacteria (92.9％),which were mainly for Acinetobacter baumanii (361 strains,17.9％),Pseudomonas aeruginosa (328 strains,16.3％),Klebsiella pneumonia (269 strains,13.3％),Stenotrophomonas naltophilia (172 strains,8.5％),Enterobacter cloacae (157 strains,7.8％),and Escherichia coli (117 strains,5.8％).A total of 143 strains were gram-positive bacteria (7.1％),which were mainly for Staphylococcus aureus (29 strains,1.4％) and Staphylococcus hamolyticus (18 strains,0.9％).Drug susceptibility results suggested the Escherichia coli and Klebsiella pneumoniae had the lowest drug tolerance rates to carbapenems and amikacin (all＜4％).During four years,ESBLs enterobacter were mainly Escherichia coli(43.6％),but the detection rate of Klebsiella pneumoniae was increasing.The top 3 drug resistance rates of Pseudomonas aeruginosa were aztreonam,imipenem and cefepime.The high resistance to various antibiotics was found in the A cinetobacter baumanii,while XDR was 49.9％.The drug-resistant staphylococcus in gram-positive bacteria were MRSA and MRSH,while no vancomycin resistant strains were found.Conclusions The pathogenic bacteria of lower respiratory tract infection are mainly gram-negative bacilli,and the main pathogenic bacteria has high drug resistance rate to the common antibiotics,and the antibiotics should be used reasonably in clinical application.