480例颅脑损伤患者医院感染的病原菌耐药性与危险因素分析  

Analysis of Risk Factors for Nosocomial Infections and Drug Resistance of Pathogens in 480 Patients with Craniocerebral Injury

作　　者：王长江[1] 费爱丽[1] 张慧[1] 涂厉标[1] 

机构地区：[1]浙江省嘉兴市第二医院药学部临床药学科,嘉兴314000

出　　处：《医药导报》2017年第9期1047-1050,共4页Herald of Medicine

摘　　要：目的分析颅脑损伤患者医院感染的病原菌耐药性与危险因素,为临床预防和治疗颅脑损伤患者医院感染提供参考。方法采用回顾性分析法,收集480例颅脑损伤患者的临床资料,采用SPSS 18.0版软件统计分析可能造成医院感染的相关危险因素。结合感染患者的病原菌培养以及药敏试验结果,分析病原菌的耐药性。结果 480例颅脑损伤患者发生医院感染100例,感染率为20.83%;年龄≥60岁、有气管插管、有深静脉置管、有气管切开、住院时间≥30 d、有糖尿病病史、血红蛋白≤110 g·L-1是颅脑损伤患者医院感染的危险因素(P<0.05)。共检出病原菌191株,其中革兰阴性菌118株,占61.8%,主要为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷白杆菌、大肠埃希菌,对头孢唑林、头孢噻肟都有较高的耐药性;革兰阳性菌46株,占24.1%,以金黄色葡萄球菌、粪肠球菌和表皮葡萄球菌为主,对青霉素和克林霉素都有较高的耐药性;真菌27株,占14.1%,以白假丝酵母菌为主。结论颅脑损伤患者医院感染的发生率较高,且与多个危险因素有关,在临床工作中应加强相关危险因素的预防控制,降低患者医院感染率。Objective To investigate the risk factors for nosocomial infections and analyze pathogens drug resistance in patients with craniocerebral injury so as to provide scientific basis for clinical precaution and treatment. Methods A retrospective sm’vey was conducted to collect the clinical data of 480 patients with craniocerebral injury including the gender, age and therapeutic process of patients by medical history, for analyzing the related factors causing nosocomial infections via SPSS 18.0 software. Then, the results of bacterial culture and drug sensitivity test were recognized to analyze drug resistance of pathogenic bacteria. Results The nosocomial infections occurred in 100 of 480 patients with craniocerebral injury, with an infection rate of 20.83%. The univariate analysis indicated that the risk of nosocomial infections was associated with age, tracheal tube, deep vein catheterization, the length of tracheotomy, the length of hospital stay, diabetic mellitus and hemoglobin ≤ 110 g ·L- 1 （P〈0.05）. Totally 191 strains of pathogens have been isolated, including 118 （61.8%） strains of gram-negative bacteria, 46 （24.1%） strains of gram-positive bacteria and 27 （14.1%） strains of fungi. The Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli were dominant among the gram-negative bacteria, and the drug resistance rates of them to cefazolin and cefotaxime were high ; The Staphylococcus aureus, Enterococcus faecalis and Staphylococcus were the major species of the gram-positive bacteria, which were insensitive to penicillin and clindamycin; the Candida albicans was the major species of the fungi. Conclusion The incidence of nosocomial infections is high in the patients with craniocerebral injury, which is accociated with many risk factors. Therefore, it is necessary to strengthen the control of the risk factors so as to effectively reduce the incidence of nosocomial infections.KEY WORDS

关 键 词：颅脑损伤 医院感染 危险因素 病原菌 耐药性 

分 类 号：R978[医药卫生—药品] R969.3[医药卫生—药学]