摘要
目的分析重度颅脑损伤患者感染病原菌的分布、感染相关因素及血清细胞因子水平变化,并探讨其临床意义。方法选取在本院接受治疗的重度颅脑损伤患者200例,其中合并肺部感染患者100例为观察组,未合并肺部感染患者100例为对照组。采集观察组患者痰液标本进行病原菌的培养及鉴定,采用药敏纸片法检测主要致病菌对常用抗菌药物的的耐药性。抽取受检者静脉血,分离血清,采用ELISA法测定高迁移率族蛋白B1(HMGB-1)和肽素(copeptin)水平,并进行比较分析。收集患者临床资料,分析重度颅脑损伤患者发生肺部感染的相关因素。结果观察组共检出病原菌106株,其中革兰阴性菌72株(67.92%),以鲍曼不动杆菌(25株,23.58%)及肺炎克雷伯菌(21株,19.81%)为主;革兰阳性菌32株(30.19%),以金黄色葡萄球菌(15株,14.15%)为主;真菌2株(1.89%)。检出的鲍曼不动杆菌和肺炎克雷伯菌对美罗培南、亚胺培南的耐药率分别为0、4.76%和8.00%、9.52%,对他唑巴坦、头孢噻肟的耐药率分别为96.00%、100.00%和100.00%、95.24%。单因素分析肺部感染的发生与患者年龄、基础疾病、抗生素使用及住院时间、呼吸机使用、气管切开等有密切关系(均P<0.05)。ELISAS检测血清HMGB-1及copeptin分别为(15.29±1.45)μg/L和(68.36±7.09) pmoL/L,对照组分别为(10.37±1.02)μg/L和(54.72±5.83) pmoL/L,差异均有统计学意义(t值分别为27.752和14.860,均P<0.05)。结论重度颅脑损伤患者肺部感染的病原菌以革兰阴性菌为主,可使用美罗培南、亚胺培南治疗。年龄偏高、合并基础疾病、抗生素使用及住院时间过长、呼吸机使用及气管切开操作等均可增加患者发生肺部感染的风险,需针对上述因素进行干预。肺部感染患者血清HMGB-1及copeptin升高,及时检测两种细胞因子水平可为病原菌的感染诊断提供参考。
Objectives To analyze the distribution of pathogens, factors related to the development of an infection, and changes in serum cytokine levels in patients with a severe craniocerebral injury and an infection, and to explore their clinical significance. Methods Subjects were 200 patients with a severe craniocerebral injury seen at this Hospital, including 100 patients with a pulmonary infection serving as the observation group and 100 patients without a pulmonary infection serving as the control group. Sputum samples were collected from patients in the infection group in strict accordance with sterile procedures. Pathogens and their drug sensitivity were detected by an automated microbial identification system. According to the standards of the American Clinical and Laboratory Standards Institute, 5 mL of venous blood was collected and serum was separated. An enzyme-linked immunosorbent assay(ELISA) was used to detect the levels of HMGB-1 and copeptin. Testing was performed in strict accordance with kit instructions. Univariate regression analysis was used to analyze the factors related to the development of a pulmonary infection in patients with a severe craniocerebral injury. The main factors analyzed included age, gender, underlying illness, duration of antibiotic use, duration of hospitalization, ventilator use, and receiving a tracheotomy. Results A total of 106 strains of pathogenic microorganisms were detected in 100 patients with a severe craniocerebral injury and a pulmonary infection. Of those, 72 were strains of Gram-negative bacteria(67.92%), which were mainly Acinetobacter baumannii(25 strains, 23.58%) and Klebsiella pneumoniae(21 strains, 19.81%);32 were strains of Gram-positive bacteria(30.19%), which were mainly Staphylococcus aureus(15 strains, 14.15%). Two strains of fungi(1.89%) were detected. A. baumannii and K. pneumoniae were resistant to meropenem at a respective rate of 0% and 4.76%, to imipenem at a rate of 8.00% and 9.52%, to tazobactam at a rate of 96.00% and 100.00% and to cefotaxime at a rate of 100.00% and 95.24%. The incidence of a pulmonary infection in patients with a severe craniocerebral injury was closely related to age, underlying illness, antibiotic use, the duration of hospitalization, ventilator use, and receiving a tracheotomy(P<0.05). The serum levels of HMGB-1 and copeptin were 15.29±1.45 μg/L and 68.36±7.09 pmol/L, respectively, according to ELISA. Serum levels in the control group were 10.37±1.02 μg/L and 54.72±5.83 pmol/L. Serum levels differed significantly between the two groups(t value: 27.752 and 14.860, respectively, P<0.05). Conclusion Gram-negative bacteria are the main pathogens causing a pulmonary infection in patients with a severe craniocerebral injury. Meropenem and imipenem can be used to treat a pulmonary infection. Being older, having an underlying illness, prolonged antibiotic use and prolonged hospitalization, ventilator use, and receiving a tracheotomy can increase the risk of developing a pulmonary infection. The serum levels of HMGB-1 and copeptin increased in patients with a pulmonary infection. The aforementioned risk factors and levels of relevant cytokines need to be monitored and dealt with. Timely detection of the levels of the two cytokines could serve as a reference for the diagnosis of a pathogen infection.
作者
李玉涛
谭赟
陆辉志
叶先智
马静
付守芝
LI Yu-tao;TAN Yun;LU Hui-zhi;YE Xian-zhi;MA Jing;FU Shou-zhi(Emergency Department ICU,Wuhan No.3 Hospital,Wuhan Hubei,China 430074)
出处
《中国病原生物学杂志》
CSCD
北大核心
2020年第6期719-722,共4页
Journal of Pathogen Biology
基金
武汉市卫计委项目(No.WX18D18)。
关键词
重度颅脑损伤
感染
病原菌
耐药性
危险因素
severe craniocerebral injury
infection
pathogens
drug resistance
risk factors
