重型颅脑外伤气管切开患者下呼吸道感染的病原菌分布及耐药性分析

发布时间：2018-07-22 10:17

【摘要】：目的分析重型颅脑外伤(sTBI)气管切开患者下呼吸道感染的病原菌分布及耐药性,为合理制订临床救治和抗感染治疗策略提供客观依据。方法选取2011年6月-2016年6月528例行气管切开的sTBI患者为研究对象,对其下呼吸道感染率、相关病原菌分布及耐药率进行研究和分析。结果 327例患者发生下呼吸道感染,感染率为61.9%;共分离出病原菌647株,革兰阴性菌、革兰阳性菌、真菌分别占78.5%、20.1%和1.4%,以铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、金黄色葡萄球菌的构成比最高,分别占30.0%、21.8%、19.0%和18.5%;在主要革兰阴性菌中,铜绿假单胞菌对氨曲南、庆大霉素、头孢派酮的耐药率较高均60.0%,肺炎克雷伯菌对哌拉西林、头孢唑肟、头孢噻肟的耐药率较高均超过80.0%,鲍氏不动杆菌对所有受试抗菌药物的耐药率均50.0%,其中,对头孢唑肟、头孢他定、头孢呋辛的耐药率均达100.0%,对氨苄西林、氨苄西林/舒巴坦的耐药率也均超过90.0%;在分离的金黄色葡萄球菌中,有87株为耐甲氧西林金黄色葡萄球菌(MRSA),检出率为72.5%,MRSA对头孢唑林、苯唑西林、青霉素G的耐药率均为100.0%,对左氧氟沙星、庆大霉素、红霉素、克林霉素的耐药率均75.0%;有33株为甲氧西林敏感性金黄色葡萄球菌(MSSA)占27.5%,MSSA对青霉素G的耐药率较高为93.9%,而对其他抗菌药物的耐药率均较低。结论 sTBI气管切开患者下呼吸道感染的病原菌分布及耐药性具有一定的特征,可根据其病原学特征合理选取敏感性抗菌药物进行治疗,提高救治成功率、改善患者预后。
[Abstract]:Objective to analyze the distribution and resistance of pathogens to lower respiratory tract infection in patients with severe craniocerebral injury (sTBI) tracheotomy. Methods 528 patients with sTBI who underwent tracheotomy from June 2011 to June 2016 were selected to study the infection rate of lower respiratory tract, distribution of related pathogens and drug resistance rate. Results the infection rate of lower respiratory tract was 61.9 in 327 patients, 647 pathogenic bacteria, Gram-negative bacteria, Gram-positive bacteria, fungi accounted for 78.5% and 1.4%, respectively. Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii were isolated. Among the main gram-negative bacteria, Pseudomonas aeruginosa showed higher resistance to aztreonam, gentamicin and cefpathinone, while Klebsiella pneumoniae was resistant to piperacillin and cefazoxime. The resistant rate of cefotaxime was higher than 80.0.The resistance rate of Acinetobacter baumannii to all tested antimicrobial agents was 50.0. Among them, the resistance rates of cefotaxime, cefuroxime and ampicillin were 100.0 and 100.0 respectively. The resistance rate of ampicillin / sulbactam was also higher than 90.0%. Of the isolated Staphylococcus aureus, 87 strains were methicillin-resistant Staphylococcus aureus (MRSA), and the detection rate was 72.5% for cefazolin and oxacillin. The drug resistance rate of penicillin G was 100.0. The drug resistance to levofloxacin, gentamicin, erythromycin, The resistance rate of clindamycin to penicillin G was higher than that of other antibiotics, and 33 strains of methicillin-sensitive Staphylococcus aureus (MSSA) accounted for 27.55.The resistance rate of MSSA to penicillin G was higher than that of other antimicrobial agents. Conclusion the distribution and drug resistance of pathogenic bacteria in patients with lower respiratory tract infection in patients with sTBI tracheotomy have certain characteristics. According to their etiological characteristics, sensitive antimicrobial agents can be reasonably selected for treatment, to improve the success rate of treatment and improve the prognosis of patients.
【作者单位】：西南医科大学附属医院神经外科;
【基金】：四川省教育厅基金资助项目(16ZB0190) 四川省科技厅基金资助项目(2016065)
【分类号】：R651.15;R56

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