重症颅脑损伤患者呼吸道分泌物病原学监测及其耐药性分析  

Monitoring the etiology of pathogens in respiratory secretions from patients with a severe craniocerebral injury and analysis of their resistance

作　　者：耿保伟[1] 原茹艳 廖鹏[1] 余政[1] 王剑波[1] 田颈[1] 邓超[1] 张入丹[1] 

机构地区：[1]重庆市涪陵中心医院神经外科,重庆408099 [2]重庆市涪陵中心医院医务科

出　　处：《中国病原生物学杂志》2017年第7期675-679,共5页Journal of Pathogen Biology

基　　金：重庆市涪陵区卫计委医学重点学科建设项目基金项目(No.2015MSXM139)

摘　　要：目的了解重症颅脑损伤患者呼吸道分泌物病原类型及其耐药情况,为临床抗感染防治提供有效指导。方法收集本院2016年1-12月就诊的411例重症颅脑损伤患者的临床资料,分析患者呼吸道分泌物病原学感染情况,用K-B法对各主要病原菌的耐药性进行检测,用PCR扩增法检测金黄色葡萄球菌耐药基因。结果从患者呼吸道分泌物中分离出128株病原菌,其中革兰阴性菌68株,革兰阳性菌46株,真菌14株。革兰阴性菌中鲍曼不动杆菌20株,肺炎克雷伯菌14株,铜绿假单胞菌12株,大肠埃希菌10株,其他革兰阴性菌12株。革兰阳性菌中金黄色葡萄球菌17株,表皮葡萄球菌12株,肺炎链球菌9株,其他革兰阳性菌14株。鲍曼不动杆菌对哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、头孢他啶、头孢噻肟、亚胺培南、美罗培南、氧氟沙星的耐药率分别为30.00%、20.00%、65.00%、50.00%、0%、10.00%、25.00%,肺炎克雷伯菌耐药率分别为14.29%、14.29%、71.43%、71.43%、0%、0%、50.00%,铜绿假单胞菌耐药率分别为50.00%、41.67%、58.33%、58.33%、16.67%、16.67%、41.67%。金黄色葡萄球菌对青霉素、红霉素、环丙沙星、万古霉素、利福平、庆大霉素、氨苄西林的耐药率分别为76.47%、64.71%、52.94%、0%、17.65%、47.06%、58.82%,表皮葡萄球菌耐药率分别为75.00%、16.67%、50.00%、0%、25.00%、50.00%、16.67%,肺炎链球菌耐药率分别为66.67%、22.22%、33.33%、0%、0%、44.44%、0%。17株金黄色葡萄球菌中mecA基因检出率为76.47%(13/17),qacA基因检出率为52.94%(9/17),ermB基因检出率为47.06%(8/17),aac(6')/aph(2")基因检出率为29.41%(5/17)。结论重症颅脑损伤患者呼吸道感染病原菌主要为革兰阴性菌,以鲍曼不动杆菌最多;革兰阳性菌感染治疗可优选万古霉素和利福平,革兰阴性菌可优选亚胺培南和美罗培南;金黄色葡萄球菌耐药程度较高,耐药基因携带率也较高。Objective To ascertain types of pathogens in respiratory secretions from patients with a severe craniocere- bral injury and to analyze the drug resistance of those pathogens in order to effectively guide the clinical prevention and treatment of infections Methods Clinical data on 411 patients with a severe cranioeerebral injury who were seen at this Hospital from January to December 2016 were collected and their respiratory secretions were analyzed for pathogens. The K-B method was used to determine the drug resistance of primary pathogens, and drug resistance genes of Staphylococcus aureus were detected via amplification with PCR. Results One hundred and twenty-eight strains of pathogens were iso- lated from the respiratory secretions of patients, including 68 strains of Gram-negative bacteria, 46 strains of Gram-posi- tive bacteria, and 14 strains of fungi. The Gram-negative strains consisted of 20 strains of A. baumannii, 14 strains of Klebsiella pneumoniae, 12 strains of Pseudomonas aeruginosa, 10 strains of Escherichia coli, and 12 strains of other bacteria. The Gram-positive strains consisted of 17 strains of S. aureus, 12 strains of S. epidermidis, 9 strains of S. pneumoniae, and 14 strains of other bacteria. The resistance of A. baumannii to piperacillin/tazobaetam was 30.00%, its resistance to cefoperazone/sulbaetam was 20.00%, its resistanee to ceftazidime was 65.00%, its resistance to eefotaxime was 50.00%, its resistance to imipenem was 0%, its resistance to meropenem was 10.00%,, and its resistance to ofloxacin was 25.00%. The resistance of K. pneurnoniae to piperacillin/tazobactam was 14. 290//00, its resistance to cefoperazone/sulbactam was 14.29 %,, its resistance to ceftazidime was 71.43 %,, its resistance to cefotaxime was 71.43 %, its re- sistance to imipenem was 0%, its resistance to meropenem was 0%, and its resistance to ofloxacin was 50.00%. The resistance of P. aeruginosa to piperacillin/tazobactam was 50.00 %, its resistance to cefoperazone/sulbactam was 41.67 %, its resistance to ceftazi

关 键 词：重症颅脑损伤 呼吸道分泌物 病原学 耐药性 

分 类 号：R378[医药卫生—病原生物学]