颈脊髓损伤患者肺部感染的病原菌特点及抗生素应用  

Pathogen of Pulmonary Infection in Patients with Cervical Spinal Cord Injury and Antibiotics Therapy

作　　者：赵国伟[1] 高钧[1] 

机构地区：[1]中国康复研究中心北京博爱医院药剂科,北京市100068

出　　处：《中国康复理论与实践》2016年第7期844-847,共4页Chinese Journal of Rehabilitation Theory and Practice

摘　　要：目的调查颈脊髓损伤（CSCI）患者肺部感染的病原菌特点及抗生素应用情况。方法回顾性分析2014年1月~2015年6月CSCI患者156例肺部感染的病原菌分布特点与耐药情况,并对临床抗生素应用情况进行分析。结果 45例患者出现68例次肺部感染,共分离出106株病原菌,其中革兰氏阴性菌76株,革兰氏阳性菌21株。在革兰氏阴性菌中,前4位分别为肺炎克雷伯菌（17.9%）、铜绿假单胞菌（15.1%）、大肠埃希菌（11.3%）、鲍曼不动杆菌（8.5%）;革兰氏阳性菌以金黄色葡萄球菌（9.4%）为主;真菌主要为热带假丝酵母菌（0.7%）。革兰氏阴性杆菌和革兰氏阳性球菌普遍呈多重耐药性,革兰氏阴性杆菌以碳青霉烯类耐药率最低,没有发现对万古霉素耐药的革兰氏阳性球菌。临床使用抗生素21种,98例次联合用药。结论 CSCI患者肺部感染以革兰氏阴性杆菌为主,常呈多药耐药;临床医生应和临床药师共同制定合理的用药方案。Objective To investigate the distribution and drug resistance of pathogen for pulmonary infection in cervical spinal cord injury（CSCI） patients, and analyze the application of antibiotics. Methods From January, 2014 to June, 2015, 156 patients with CSCI were reviewed. The bacteriology and drug resistance were investigated, as well as the application of antibiotics. Results There were 45 cases with nosocomial infection of 68 times, and 106 strains of bacteria in total. The top four Gram- negative pathogens were Klebsiella pneumonia（17.9%）, Pseudomonas aeruginosae（15.1%）, Encherichia coli（11.3%） and Acinetobacter baumannii（8.5%）. The main Gram-positive cocci was Staphylococcus aureus（9.4%）, and the main fungi was Candida tropicalis（0.7%）. Gram-negative bacteria was resistant to the second or third generation cephalosporins and quinolones moderately or severely, but sensitive to β-lactamase inhibitor combinations and aminoglycosides. The main Gram-positive cocci were sensitive to vancomycin. The application of antibiotics needed to be improved. Conclusion The Gram-negative bacteria are the chief pathogen for pulmonary infection in CSCI patients, which show multiple drug-resistant. It is significant to monitor the drug resistance of bacteria and optimize antibiotics.

关 键 词：颈脊髓损伤 肺部感染 病原菌 耐药 抗生素 

分 类 号：R651.2[医药卫生—外科学]