神经外科下呼吸道感染5年临床研究  

Lower Respiratory Infection in Neurosurgery: A5 Year Clinical Study

作　　者：吴承[1] 熊怀民[1] 屈振东[1] 姚乾[1] 卢少波[1] 

机构地区：[1]常熟市第二人民医院,江苏常熟215500

出　　处：《中华医院感染学杂志》2005年第8期888-891,共4页Chinese Journal of Nosocomiology

摘　　要：目的了解神经外科患者下呼吸道感染细菌的流行及变迁的规律,为危重病患者的抗感染治疗提供依据. 方法 对2000年1月～2004年12月,5年神经外科患者下呼吸道分离的 547株细菌用MicroScan WalkAway40全自动微生物鉴定仪鉴定. 结果神经外科下呼吸道感染率为6.97%;其中G-菌49.7%(272株),G+菌42.0%(230株),真菌7.5%(41株);G-菌中以克雷伯菌属,肠杆菌属,嗜麦芽寡养单胞菌,铜绿假单胞菌,大肠埃希菌为主,共占42.7%,5种细菌占G-菌总数的86.0%;其中克雷伯菌属第1位,其在G-菌中占15.7%;G+菌中以葡萄球菌属与肠球菌属为主,共占G+菌的38.0%;金黄色葡萄球菌是首位,其在G+菌占17.7%;G+菌中耐苯唑西林金黄色葡萄球菌(MRSA)96.9%,克雷伯菌属与大肠埃希菌的ESBLs检出率分别为44.2%,53.6%;深部真菌以白色念珠菌为主占61.0%. 结论神经外科下呼吸道感染的主要致病菌常为多重耐药菌和条件致病菌;亚胺培南、头孢哌酮/舒巴坦对所有神经外科下呼吸道感染的G-菌都保持着良好的活性,万古霉素对所有神经外科下呼吸道感染的G+菌保持高度敏感性;肠杆菌属、肠球菌属感染的快速上升是值得关注的问题.OBJECTIVE To study the distribution and diversity of the bacteria of lower respiratory tract infections in neurosurgery to provide basis for treatment of such patients. METHODS Microscan WalkAway-40 system was used to identify the antibiotic resistance of 547 isolated strains automatically during from Jan 2000 to Dec 2004.RESULTS The bacterial infection rate of lower respiratory tract in neurosurgery was 6.97 ％. Among all isolated strains, the Gram negative bacilli were 272 strains （49.7％）, the Gram positive cocci were 230 strains （42.0％）and fungi were 41 strains （7.5％）. Klebsiella, Enterobacter, Stenotrophomonas maltophilia, Pseudomonas aeruginosa, and Escherichia coli were the main Gram negative bacilli （42.7％）. they were 86.0％ in the total of negative bacilli. Klebsiella were the most prominent in the isolated of Gram negative bacilli （15.7％）.Staphylococcus and Enterococcus were the main Gram positive cocci （38.0％）. Staphylococcus aureus was the most prominent in the isolated of Gram positive cocci （17.7％）. MRSA accounted for 96. 9％（94/97） of the isolated S. aureus. The isolated strains of the Klebsiella with ESBLs were for 44.2％ （38/86）, and the E. coli with ESBLs for 53.6％（15/28）. The most of the isolated fungi were Candida albicans 61.0％ （25/41）.CONCLUSIONS Major cause of the bacterial infection of the lower respairatory tract in our neurosurgery, isbacteria which are multidrug-resitant and conditioned pathogens. In our neurosurgery, imipenem amd cefoperazone/sulbactam are better active agents for all Gram negative bacilli isolated strains from lower respiratory tract. While vancomycin is the most active agent against Gram positive cocci. What is worth noticing is that the infection of Enterobacter and Enterococcus are increasing quickly.

关 键 词：细菌 感染 耐药性 

分 类 号：R651.1[医药卫生—外科学]