Abstract: Objective　To analyze the results of the pathogens distribution and antibiogram in patients with emergency healthcare-associated pneumonia （HCAP），so as to provide the basis for rational use of antibiotics in the region.Methods　A total of 783 emergency inpatients with HCAP admitted to the First Affiliated Hospital of Xinjiang Medical University，according to the age distribution，were divided into the younger group（364 cases） and the elderly group（419 cases）from November 2014 to April 2017.The baseline data，specimen culture，pathogens distribution and antibiogram were analyzed.Results　The elderly group was significantly more likely to have hypertension，cardiovascular disease，diabetes mellitus，chronic lung disease，solid organ malignancy，≥ 2 basic diseases and high systolic pressure （P<0.05），whereas younger group were significantly more likely to have nervous system disorders，hematologic deisease，rheumatologic disease，peripheral vascular disease and lower temperature than the elderly group （P<0.05）．Among the 783 patients，783 strains were detected，of which 573 were from sputum culture （73.2%），171 from tracheal or bronchial aspirates （21.8%） and 39 from bronchoalveolar lavage fluid （5.0%）．There were 27 kinds of Gram-negative bacilli，9 kinds of Gram-positive cocci and 1 kind of fungus.Gram-negative bacteria were the most common pathogens in both groups〔86.0%（313/364） and 85.2%（357/419）〕．The order of pathogenic bacteria was Acinetobacter baumannii 〔25.3%（92/394） and 29.1%（122/419）〕，Klebsiella pneumoniae 〔25.8%（94/364） and 21.0%（88/419）〕，Pseudomonas aeruginosa 〔12.1%（44/364） and 9.3%（39/419）〕，Staphylococcus aureus 〔8.5%（31/364） and 8.4%（35/419）〕 and Escherichia coli 〔5.8%（21/364） and 8.8%（37/419）〕，with the drug resistance of Acinetobacter baumannii the most critical.The most Gram negative bacilli was generally drug-resistant to Penicillins，the first and second generation cephalosporin，and sensitive to carbapenem，sulfamethoxazole and polymyxin B.The drug resistance rate of Klebsiella pneumoniae and Escherichia coli to the third generation cephalosporin were 26.4%，62.1%，respectively，and the drug resistance rate of Acinetobacter baumannii，Klebsiella pneumoniae，Pseudomonas aeruginosa and Escherichia coli to carbapenem were 71.5%，1.1%，30.1%，1.7%，respectively.Conclusion　The majority of HCAP patients were elderly men.Age has little influence on the etiology of HCAP.The distribution and drug resistance of HCAP pathogens in this region have regional characteristics，clinicians should rationally use antibiotics according to specific circumstances.

Key words: Healthcare-associated pneumonia, Emergency treatment, Pathogens, Microbial sensitivity tests

摘要： 目的　对急诊医疗保健相关性肺炎（HCAP）患者病原体分布及耐药特点进行分析，为地域性抗生素的合理使用提供依据。方法　选取2014年11月—2017年4月就诊于新疆医科大学第一附属医院急诊科的标本培养结果阳性的急诊HCAP成年患者783例，根据年龄将其分为非高龄组（364例）和高龄组（419例）。记录并分析患者一般资料、标本培养及药物敏感试验结果。结果　高龄组高血压、心血管疾病、糖尿病、慢性肺部疾病、肿瘤、≥2种基础疾病所占比例、收缩压均高于非高龄组，神经系统疾病、血液病、风湿免疫系统疾病、外周血管疾病所占比例、体温均低于非高龄组（P<0.05）。783例患者中，共检出783株病原体，其中痰培养573株（73.2%）、气管支气管吸取物171株（21.8%）、支气管肺泡灌洗液39株（5.0%）；包括27种革兰阴性杆菌、9种革兰阳性球菌、1种真菌等。非高龄组与高龄组均以革兰阴性杆菌为主〔86.0%（313/364）与85.2%（357/419）〕，前5位细菌为鲍曼不动杆菌〔25.3%（92/394）与29.1%（122/419）〕、肺炎克雷伯菌〔25.8%（94/364）与21.0%（88/419）〕、铜绿假单胞菌〔12.1%（44/364）与9.3%（39/419）〕、金黄色葡萄球菌〔8.5%（31/364）与8.4%（35/419）〕、大肠埃希菌〔5.8%（21/364）与8.8%（37/419）〕。鲍曼不动杆菌的耐药情况最为严重，大部分革兰阴性杆菌对青霉素类、第一代头孢菌素、第二代头孢菌素耐药性高，但对碳青霉烯类、复方新诺明、多黏菌素B敏感性高。肺炎克雷伯菌、大肠埃希菌对第三代头孢菌素的耐药率分别为26.4%、62.1%，而鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌对碳青霉烯类耐药率分别为71.5%、1.1%、30.1%、1.7%。结论　HCAP成年患者以老年男性居多，年龄对HCAP病原学影响较小。本地区HCAP病原体分布及耐药情况具有地域特点，临床医师应根据具体情况合理使用抗生素。

关键词: 医疗保健相关性肺炎, 急诊处理, 病原体, 微生物敏感性试验