开颅术后危重患者医院感染病原菌分布及耐药性分析

发布时间：2019-08-04 10:04

【摘要】：目的分析开颅手术后危重患者感染的病原菌分布及其耐药性,为临床控制术后感染提供参考依据。方法选取2012年6月-2016年6月医院行开颅手术患者584例,对发生术后颅内感染的52例患者进行细菌培养和药敏试验,分析感染患者的感染率、病原菌分布及其耐药性;采用法国生物梅里埃公司VITEK-2Compact全自动鉴定仪对菌株进行鉴定,采用纸片法进行药敏检测,采用SPSS19.0软件对数据进行统计分析。结果 584例开颅手术患者中52例患者发生术后颅内感染,感染率为8.9%;共分离出52株病原菌,其中革兰阴性菌36株,占69.2%,以肺炎克雷伯菌和鲍氏不动杆菌为主,分别占30.8%和26.9%,革兰阳性菌14株,占26.9%,以金黄色葡萄球菌和表皮葡萄球菌为主,均占11.5%,真菌2株,占3.9%;革兰阴性菌中鲍氏不动杆菌对头孢曲松耐药率最高,为78.6%,对环丙沙星耐药率最低,为21.4%,肺炎克雷伯菌对氨曲南及环丙沙星耐药率最高,为81.3%,对亚胺培南耐药率最低,为12.5%;革兰阳性菌中表皮葡萄球菌对青霉素耐药率最高,为100.0%,对万古霉素及利奈唑胺耐药率最低,为0,金黄色葡萄球菌对红霉素耐药率最高,为83.3%,对万古霉素及利奈唑胺耐药率最低,为0。结论开颅手术后有较高的感染风险,术后感染病原菌以革兰阴性菌为主,且革兰阴性菌对多种药物都具有耐药性,在术后治疗阶段需加强对病原菌的监控,从而进行有效干预,控制病原菌感染,保障患者预后。
[Abstract]:Objective to analyze the distribution and drug resistance of pathogenic bacteria in critically ill patients after craniotomy, and to provide reference for clinical control of postoperative infection. Methods 584 patients undergoing craniotomy from June 2012 to June 2016 were selected to carry out bacterial culture and drug sensitivity test in 52 patients with postoperative intracranial infection, and the infection rate, pathogen distribution and drug resistance of the infected patients were analyzed, the strains were identified by VITEK-2Compact automatic identification instrument of French biological Merry company, the drug sensitivity was detected by paper method, and the data were statistically analyzed by SPSS19.0 software. Results Intracranial infection occurred in 52 of 584 patients undergoing craniotomy, the infection rate was 8.9%. A total of 52 strains of pathogenic bacteria were isolated, including 36 strains of Gram-negative bacteria (69.2%), mainly Klebsiella pneumoniae and Acinetobacter baumannii (30.8% and 26.9%), 14 strains of Gram-positive bacteria (26.9%), mainly Staphylococcus aureus and Staphylococcus epidermidis (11.5%) and 2 strains of fungi (3.9%). Among Gram-negative bacteria, Acinetobacter baumannii had the highest resistance to ceftriaxone (78.6%), ciprofloxacin (21.4%), Klebsiella pneumoniae (81.3%) and imipenem (12.5%). Among Gram-positive bacteria, Staphylococcus epidermidis had the highest resistance to penicillin (100.0%), vancomycin and linazolamide (0), Staphylococcus aureus (83. 3%) and vancomycin (0). Conclusion there is a high risk of infection after craniotomy. Gram-negative bacteria are the main pathogenic bacteria after craniotomy, and Gram-negative bacteria are resistant to a variety of drugs. It is necessary to strengthen the monitoring of pathogenic bacteria in the stage of postoperative treatment, so as to carry out effective intervention, control pathogen infection and ensure the prognosis of patients.
【作者单位】：四川省科学城医院四川中医药高等专科学校附属医院神经外科;四川中医药高等专科学校;
【分类号】：R651.1

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