重症颅脑损伤患者呼吸道分泌物病原学监测及其耐药性分析

发布时间：2018-08-18 16:48

【摘要】：目的了解重症颅脑损伤患者呼吸道分泌物病原类型及其耐药情况,为临床抗感染防治提供有效指导。方法收集本院2016年1-12月就诊的411例重症颅脑损伤患者的临床资料,分析患者呼吸道分泌物病原学感染情况,用K-B法对各主要病原菌的耐药性进行检测,用PCR扩增法检测金黄色葡萄球菌耐药基因。结果从患者呼吸道分泌物中分离出128株病原菌,其中革兰阴性菌68株,革兰阳性菌46株,真菌14株。革兰阴性菌中鲍曼不动杆菌20株,肺炎克雷伯菌14株,铜绿假单胞菌12株,大肠埃希菌10株,其他革兰阴性菌12株。革兰阳性菌中金黄色葡萄球菌17株,表皮葡萄球菌12株,肺炎链球菌9株,其他革兰阳性菌14株。鲍曼不动杆菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢他啶、头孢噻肟、亚胺培南、美罗培南、氧氟沙星的耐药率分别为30.00%、20.00%、65.00%、50.00%、0%、10.00%、25.00%,肺炎克雷伯菌耐药率分别为14.29%、14.29%、71.43%、71.43%、0%、0%、50.00%,铜绿假单胞菌耐药率分别为50.00%、41.67%、58.33%、58.33%、16.67%、16.67%、41.67%。金黄色葡萄球菌对青霉素、红霉素、环丙沙星、万古霉素、利福平、庆大霉素、氨苄西林的耐药率分别为76.47%、64.71%、52.94%、0%、17.65%、47.06%、58.82%,表皮葡萄球菌耐药率分别为75.00%、16.67%、50.00%、0%、25.00%、50.00%、16.67%,肺炎链球菌耐药率分别为66.67%、22.22%、33.33%、0%、0%、44.44%、0%。17株金黄色葡萄球菌中mecA基因检出率为76.47%(13/17),qacA基因检出率为52.94%(9/17),ermB基因检出率为47.06%(8/17),aac(6')/aph(2")基因检出率为29.41%(5/17)。结论重症颅脑损伤患者呼吸道感染病原菌主要为革兰阴性菌,以鲍曼不动杆菌最多;革兰阳性菌感染治疗可优选万古霉素和利福平,革兰阴性菌可优选亚胺培南和美罗培南;金黄色葡萄球菌耐药程度较高,耐药基因携带率也较高。
[Abstract]:Objective to investigate the pathogenic types and drug resistance of respiratory secretions in patients with severe craniocerebral injury, and to provide effective guidance for the prevention and treatment of clinical anti-infection. Methods the clinical data of 411 patients with severe craniocerebral injury in our hospital from January to December 2016 were collected, and the pathogenic infection of respiratory secretion was analyzed. The drug resistance of the main pathogens was detected by K-B method. Staphylococcus aureus resistance gene was detected by PCR amplification. Results 128 strains of pathogenic bacteria were isolated from the respiratory secretions of the patients, including 68 Gram-negative bacteria, 46 Gram-positive bacteria and 14 fungi. There were 20 Acinetobacter baumannii, 14 Klebsiella pneumoniae, 12 Pseudomonas aeruginosa, 10 Escherichia coli and 12 other Gram-negative bacteria. There were 17 strains of Staphylococcus aureus, 12 strains of Staphylococcus epidermidis, 9 strains of Streptococcus pneumoniae and 14 strains of other Gram-positive bacteria. Acinetobacter baumannii p-piperacillin / tazobactam, cefoperazone / sulbactam, ceftazidime, cefotaxime, imipenem, meropenem, The drug resistance rates of ofloxacin were 30.002 / 20.00 and 65.00 / 55.00, respectively. There were 55.00 and 25.00, respectively. The drug resistance rate of Klebsiella pneumoniae was 14.2929 14.2914.290.The drug resistance rate of Pseudomonas aeruginosa was 50.0041.6758.338.338.3316.6716. 67 and the resistance rate of Pseudomonas aeruginosa was 41.67. Staphylococcus aureus, penicillin, erythromycin, ciprofloxacin, vancomycin, rifampicin, gentamicin, 姘ㄨ媱瑗挎灄鐨勮，

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