颅脑外伤患者医院感染的病原学及危险因素分析  

Analysis of risk factors for nosocomial infection and pathogens infecting patients with craniocerebral trauma

作　　者：张继跃[1] 王瑞玲[1] 刘慧君[1] ZHANG Ji-yao;WANG Rui-ling;LIU Hui-jun(Jining Medical College Hospital,Jining 272029,Shandong,China)

机构地区：[1]济宁医学院附属医院,山东济宁272029

出　　处：《中国病原生物学杂志》2018年第8期889-892,共4页Journal of Pathogen Biology

摘　　要：目的分析颅脑外伤合并医院感染患者感染病原菌的种类、耐药性及医院感染的危险因素。方法 2015年7月-2017年7月本院收治的颅脑外伤患者400例,采用全自动细菌鉴定分析仪和药敏试验检测患者发生医院感染的病原菌构成及耐药性;回顾性分析患者临床资料,对造成医院感染的危险因素进行单因素方差分析。结果 400例颅脑损伤患者发生医院感染90例,感染率为22.50%。90例感染患者共检出病原菌128株,其中革兰阴性菌79株(占61.72%),对美罗培南及亚胺培南较敏感,对氨苄西林及头孢唑林敏感性较差,耐药率85%~100%。大肠埃希菌分离株对头孢哌酮、头孢呋辛较为敏感,鲍曼不动杆菌分离株对氨曲南较为敏感。革兰阳性菌35株,占27.34%,以金黄色葡萄球菌和表皮葡萄球菌为主,对青霉素、红霉素、氨苄西林高度耐药,对利奈唑胺、喹奴普汀/达福普汀、利福平、万古霉素较敏感。真菌14株,占10.94%,以白假丝酵母菌为主。单因此方差分析显示,年龄(≥60)、住院时间(≥30d)、血红蛋白含量(<110g/L)、气管切开、气管插管、深静脉置管、糖尿病病史等均为颅脑损伤患者发生医院感染的危险因素(P<0.05)。结论颅脑外伤患者发生医院感染概率较高,且与年龄、住院时间、侵入性操作及糖尿病病史等多种危险因素有关。因此应加强对相关危险因素的控制,以降低颅脑外伤患者发生医院感染的风险,提高治疗效果。Objective To analyze the type of nosocomial infections developed by patients with craniocerebral trauma,risk factors for infection,and the drug resistance of the pathogens causing those infections. Methods Subjects were 400 patients with craniocerebral trauma seen at this Hospital from July 2015 to July-2017.Pathogens causing a nosocomial infection were detected and their drug resistance was analyzed.Clinical data and risk factors for nosocomial infection were retrospectively analyzed. Results Of the 400 patients with a craniocerebral injury,90 developed a nosocomial infection for a rate of infection of 22.50%.In specimens from the 90 patients with an infection,128 strains of pathogenic bacteria were detected.There were 79 strains of Gram-negative bacteria,accounting for 61.72% of the total isolates.Gram-negative bacteria had little sensitivity to ampicillin and cefazolin,and their resistance ranged from 85-100%.Escherichia coli was sensitive to cefoperazone and cefuroxime,and Acinetobacter baumannii was sensitive to aztreonam.Gram-negative bacteria were more sensitive to meropenem and imipenem.There were 35 strains of Gram-positive bacteria,accounting for27.34% of the total isolates.Gram-positive bacteria were mainly Staphylococcus aureus and Staphylococcus epidermidis.Gram-positive bacteria were highly resistant to penicillin,erythromycin and ampicillin and were sensitive to linezolid,quinupristin/dalfopristin,rifampicin,and vancomycin.There were 14 strains of fungi,accounting for 10.94% of the total isolates.Fungi were mainly Candida albicans.Univariate analysis indicated that the risk of nosocomial infections was associated with age,duration of hospitalization,hemoglobin≤110 g/L,a tracheotomy,placement of a tracheal tube,deep vein catheterization,and diabetes mellitus. Conclusion Patients with craniocerebral trauma are likely to develop a nosocomial infection.This is related to many risk factors,such as age,duration of hospitalization,undergoing invasive surgery,and a history of diabetes.Management of relat

关 键 词：颅脑外伤 医院感染 危险因素 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]