摘要
目的了解重度颅脑外伤患者气管切开术后继发肺部感染的病原菌分布及其药敏性,为预防与控制神经外科病房医院感染提供试验依据。方法回顾性分析2009年1月-2012年12月收治的204例重度颅脑外伤气管切开术患者临床资料,探讨肺部感染相关因素,并对病原菌分布及其药敏性进行分析,采用法国生物梅里埃公司VITEK-32型全自动微生物鉴定与药敏分析仪鉴定病原菌种类,药敏试验采用K-B琼脂纸片扩散法进行检测。结果 204例重度颅脑外伤患者造成肺部感染的因素主要为气管切开、昏迷时间>7d、颅脑手术、误吸呕吐物,分别占31.4%、28.9%、16.7%、13.2%;共检出病原菌281株,其中革兰阴性菌208株占74.0%,革兰阳性菌56株占19.9%,真菌17株占6.1%;革兰阴性菌中鲍氏不动杆菌、肺炎克雷伯菌对亚胺培南的敏感率均为100.0%;铜绿假单胞菌对亚胺培南、头孢吡肟、头孢唑肟、左氧氟沙星的敏感率分别为96.7%、78.0%、75.8%、42.9%。结论重度颅脑外伤患者发生肺部感染的主要因素有气管切开、昏迷时间>7d、颅脑手术、误吸呕吐物,通过监测病原菌的分布、变化及其药敏特点,可确立合理的抗菌药物应用方案,有利于控制医院感染。
OBJECTIVE To find out the pathogenic bacteria distrinibution in severe traumatic brain injury patients with pulmonary infection after tracheotomy and its drug susceptibility, to provide scietntyie basis for the prevention and control of hospital infections in neurosurgery ward. METHODS The clinical data of 204 cases of severe traumatic brain injury patients from Jan 2009 to Dec 2012 were analyzed retrospectively. The related factors about pulmonary infection were investigated. VITEK-32 fully automatic microbial identification and drug sensitivity analyzer was used to identify the pathogens and K-B the AGAR disc diffusion method was used to detected the susceptibility. RESULTS The primary incentives of pulmonary infection were tracheotomy, coma exceedings 7 days, brain surgery and aspiration vomitus, accounting for 31. 4 %, 28. 9 %, 16. 7 % and 13. 2 %, respectively. A total of 281 strains of pathogenic bacteria were detected, among which gram-negative bacteria 208 strains, accounting for 74.02 %, gram-positive bacteria 56 strains （19. 9 %）, fungi 17 strains （6. 1 %）. Among the gram-negative bacteria, the sensitivity rates of Acinetobacter baumannii , Klebsiella pneumoniae to imipenem were both 100%. The sensitive rates of P. aeruginosa to Imipenern , cefepime , ceftizoxime and levofloxacin were 96.7%, 78.0%, 75.8% and 42. 9 %, respecitively. CONCLUSION The main factors of causing pulmonary infection to traumatic brain injury patients were tracheotomy, coma time exceedings 7 days, brain surgery and aspiration vomitus. By monitoring the distribution of pathogens, changes and susceptibility characteristics, rational antimicrobial application solutions can be established, and nosocomial infections can be controlled.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2014年第5期1212-1214,共3页
Chinese Journal of Nosocomiology
基金
浙江省中医药重点学科建设基金资助项目(2012-XK-A03)
关键词
重度颅脑外伤
气管切开术
肺部感染
医院感染
病原菌
Severe brain injury
Tracheotomy
Pulmonary infection
Hospital infection
Pathogenic bacteria
