脑出血术后患者下呼吸道感染的临床分析  

Clinical analysis of lower respiratory tract infections in patients treated with cerebral hemorrhage surgery

作　　者：李明艳[1] 周定球[2] 刘全[2] 赖军华[3] 

机构地区：[1]广西医科大学第四附属医院药学部,广西柳州545005 [2]广西医科大学第四附属医院神经外科,广西柳州545005 [3]广西医科大学第四附属医院 [3]广西医科大学第四附属医院ICU,广西柳州545005

出　　处：《中华医院感染学杂志》2014年第17期4298-4300,共3页Chinese Journal of Nosocomiology

基　　金：广西科学研究与技术开发计划基金项目(桂科攻1140003A-43)

摘　　要：目的了解脑出血术后患者并发下呼吸道感染的特点及病原菌分布,以便更好的指导临床用药,提高患者治愈率。方法回顾性分析医院2012年4月-2013年3月脑出血术后发生下呼吸道感染的98例患者资料,对其病原菌分布及耐药性进行统计分析,对抗感染治疗的效果进行分析总结;参照《全国临床检验操作规程》和《诊断细菌学常规方法》对病原菌进行培养鉴定,对于培养阳性者进行体外药敏试验,结果按美国临床实验室标准化委员会标准进行判定。结果 98例患者中共检出病原菌121株,以革兰阴性菌为主占67.77%,革兰阳性菌占18.18%,真菌占14.05%,检出率排前5位的病原菌依次为鲍氏不动杆菌、金黄色葡萄球菌、铜绿假单胞菌、嗜麦芽寡养单胞菌、肺炎克雷伯菌,分别占19.83%、16.53%、14.05%、11.57%、10.74%;鲍氏不动杆菌对亚胺培南耐药率最低,为20.83%,肺炎克雷伯菌及大肠埃希菌产ESBLs率分别为81.8%及88.9%,但是未检出对碳青霉烯类耐药菌株;金黄色葡萄球菌中,MRSA检出率为80.00%,对万古霉素全部敏感;白色假丝酵母菌和热带假丝酵母菌对氟康唑、伊曲康唑等抗真菌药均敏感。结论脑出血术后下呼吸道感染的病原菌耐药性高,临床上应以预防为主、加强患者免疫力、配合肺灌洗等措施,合理使用抗菌药物。OBJECTIVE To learn about the characteristics of lower respiratory tract infections and pathogen distribution in patients treated with cerebral hemorrhage surgery so as to better instruct the use of drugs in clinical practice and improve the cure rate. METHODS The clinical data of 98 cases of patients who suffered lower respiratory tract infections after receiving cerebral hemorrhage surgery from April 2012 to March 2013 were retrospectively analyzed, the pathogen distribution and drug resistance were statistically analyzed, and the anti-infection effect was summarized and analyzed. The pathogens were cultured for identification as per National Clinical Laboratory Procedures and Conventional Diagnostic Methods of Bacteriology, and the pathogens of positive culture were thrown into in vitro drug sensitivity test and the results were determined according to the standard issued by Clinical and Laboratory Standards Institute. RESULTS A total of 121 strains of pathogens were detected in 98 patients, including gram-negative bacteria （67.77%）, gram-positive bacteria （18. 18%） and fungi （14.05%）. The pathogens with top 5 detection rates were Acinetobacter baumannii （A. baumannii） , Staphylococcus aureus（ S. aureus） , Pseudomonas aeruginosa （19. aeruglnosa） , Stenotrophomonas rnaltophilia （S. maltophilia） , and Klebsiella pneumoniae （K. pneumoniae）, accounting for 19.83 %, 16.53 %, 14.05 %, 11.57 % and 10.74 % respectively. A. baumannii had the lowest drug resistance rate of 20.83% to imipenem% the ESBLs production rates of K. pneumoniae and Escherichia coli （E. coli） were 81.8% and 88.9% respectively, however, the carbapenems-resistant strains were not detected out ; among the S. aureus, the detection rate of methicillin-resistant S. aureus（MRSA） was 80.00%.%0, and all the S. aureus were sensitive to vancomycin; Candida albicans （C. albicans） and Candida tropicalis（C, tropicalis） were sensitive to antifungal agents like fluconazole and itraconazole. CONCLUSION Thepathogens c

关 键 词：脑出血 下呼吸道感染 病原菌 治疗 

分 类 号：R563[医药卫生—呼吸系统]