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 of pathogenic bacteria and drug resistance of lower respiratory tract infection in patients with severe craniocerebral trauma (sTBI), and to provide an objective basis for the rational formulation of clinical treatment and anti infection treatment strategies. Methods 528 patients with tracheotomy in June 2011, -2016 year, were selected as research subjects, and the incidence of lower respiratory tract infection and related pathogens were investigated. The distribution and resistance rate of bacteria were studied and analyzed. Results 327 patients had lower respiratory tract infection, the infection rate was 61.9%, 647 strains of pathogenic bacteria were isolated, Gram-negative bacteria, Gram-positive bacteria and fungi accounted for 78.5%, 20.1% and 1.4% respectively, and the composition ratio of Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii and Staphylococcus aureus was the highest. 30%, 21.8%, 19% and 18.5%, respectively, among the major Gram-negative bacteria, the resistance rate of Pseudomonas aeruginosa to amametin, gentamicin and ceftazinone was 60%. The resistance rate of Klebsiella pneumoniae to piperacillin, ceftaxime, cefotaxime was higher than 80%, and the resistance rate of Acinetobacter baumannii to all the tested antibiotics was 5. 0%, among them, the resistance rate to cefzoxime, ceftazine and cefuroxime was 100%, and the resistance rate to ampicillin and ampicillin / sulbactam was also more than 90%; in the isolated Staphylococcus aureus, 87 strains were methicillin resistant Staphylococcus aureus (MRSA), the detection rate was 72.5%, and MRSA against cefazolin, oxacillin, penicillin G. The drug resistance rate was 100%. The resistance rates to levofloxacin, gentamicin, erythromycin and clindamycin were all 75%, 33 were methoxicillin sensitive Staphylococcus aureus (MSSA) 27.5%, and the resistance rate of MSSA to penicillin G was 93.9%, while the rate of other antibiotics was low. Conclusion sTBI tracheotomy patients lower respiratory tract. Conclusion the lower respiratory tract of patients with sTBI tracheotomy is lower. The distribution and drug resistance of the infected pathogens have certain characteristics, and the sensitive and antibacterial drugs can be selected according to their etiological characteristics to improve the success rate of treatment and improve the prognosis of the 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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