470例重型颅脑损伤患者气管切开后并发肺部感染的病原菌分析  

Analysis of pathogens of pulmonary infection following tracheostomy in 470 patients with severe traumatic brain injury

作　　者：高杲[1] 魏伟[2] 江红[1] 汤正好[1] 臧国庆[1] 

机构地区：[1]上海交通大学附属第六人民医院感染科,上海市200233 [2]上海交通大学附属第六人民医院神经外科,上海市200233

出　　处：《中华全科医学》2015年第12期1952-1954,共3页Chinese Journal of General Practice

摘　　要：目的研究重型颅脑损伤气管切开后并发肺部感染患者病原菌分布及耐药性。方法收集470例气管切开后重型颅脑损伤患者下呼吸道分泌物进行病原菌培养及药敏试验,对耐药情况进行分析。结果 337例患者发生肺部感染,分离出病原菌572株,主要为革兰阴性(G-)菌452株(占79.0%),铜绿假单胞菌最常见171株(占29.9%),其次为肺炎克雷伯菌及鲍曼不动杆菌。革兰阳性(G+)菌110株(占19.2%),金葡菌106株,其中耐甲氧西林金葡菌(MRSA)78株(占73.6%)。铜绿假单胞对除哌拉西林/他唑巴坦及阿米卡星以外抗菌药物耐药率达到30%以上。肺炎克雷伯菌对阿米卡星耐药率低,但已发现耐碳青霉烯类肺炎克雷伯菌。鲍曼不动杆菌对所有检测的抗菌药物普遍耐药。未发现耐万古霉素、替考拉宁及利奈唑胺的MRSA。MRSA对复方新诺明耐药率低,但对其他抗菌药物耐药率极高。结论气管切开后重型颅脑损伤患者肺部感染患病率高,病原菌以G-菌为主,多为多重耐药菌株。临床上应加强病原菌培养及耐药性监测,合理使用抗生素,做好床边隔离、手卫生等消毒措施以减少院内感染的发生和传播。Objective To investigate the pathogens distribution and drug resistance of pulmonary infection following tracheostomy in patients with severe traumatic brain injury. Methods The lower respiration secretion of 470 patients with severe traumatic brain injury was collected after the tracheotomy for culture and susceptibility test. Results A total of337 patients were with pulmonary infection,572 pathogens were identified from the sputum,including 452 gram-negative bacteria（ 79. 0%）,among them Pseudomonas aeruginosa accounted for 29. 9%（ 171 /452）,followed by Klebsiella pneumoniae and Acinetobacter baumannii,and 110 Gram-positive bacteria（ 19. 2%）,with the Stphylococcus aureus occupying the most（ 106 /110）,the prevalence of methicillin-resistant Staphylococus aureus（ MRSA） was 73. 6%（ 78 /106）. Pseudomonas aeruginosa showed high resistance rates of more than 30% to the used antibiotics except for piperacillin / tazobactam and amikacin. Klebsiella pneumoniae showed the lowest resistance to amikacin,though a few imipenem and meropenem resistant strains were identified. Acinetobacter baumannii were found resistant to all the used antibiotics. No MRSA were found resistant to vancomycin,teicoplanin or linezolid. However,the resistant rates were high of MRSA to other used antibiotics except for SMZ-TMP. The results of drug sensitive test showed the multiple drug resistance for most pathogens.Conclusion The prevalence of pulmonary infection following the tracheotomy was high in patients with severe traumatic brain injury. Gram-negative bacteria were the major isolates. Most of the isolates were multi drug resistant strains. It is important to monitor the change of bacterial drug resistance and choose appropriate antibiotics,as well as strengthen disinfection and hand hygiene to decrease the incidence and spread of nosocomial infection.

关 键 词：气管切开 重型颅脑损伤 肺部感染 病原菌 耐药性 

分 类 号：R651.15[医药卫生—外科学] R563.1[医药卫生—临床医学]