颅脑外伤昏迷患者发生呼吸机相关性肺炎的病原菌分布及相关因素分析  

Distribution of pathogens isolated from craniocerebral trauma and coma patients with ventilator-associated pneumonia and related factors

作　　者：张晓梅[1] 仲悦萍[2] 陈晓艳[1] 苏星[1] ZHANG Xiao-mei;ZHONG Yue-ping;CHEN Xiao-yan;SU Xing(Affiliated Hospital of Nantong University,Nantong,Jiangsu 226001,China)

机构地区：[1]南通大学附属医院神经外科,江苏南通226001 [2]南通大学附属医院外科,江苏南通226001

出　　处：《中华医院感染学杂志》2020年第1期96-100,共5页Chinese Journal of Nosocomiology

基　　金：江苏省“六大人才高峰”基金资助项目(WSW-028)。

摘　　要：目的分析颅脑外伤昏迷患者发生呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的病原菌分布及相关因素,为医院感染的预防和控制提供研究依据。方法选取2016年7月-2018年7月医院收治的222例颅脑外伤昏迷患者作为研究对象,对其VAP发生情况、病原菌分布及相关因素进行回顾性分析。结果 222例颅脑外伤昏迷患者中78例患者发生VAP,发生率为35.14%。65例患者的痰标本中分离出病原菌,检出率为83.33%。共检出77株病原菌,其中35株为革兰阳性菌占45.45%,以金黄色葡萄球菌、表皮葡萄球菌为主;37株为革兰阴性菌占48.05%,以铜绿假单胞菌、鲍氏不动杆菌为主;5株为真菌占6.49%,以白假丝酵母为主。主要革兰阳性菌对青霉素G、红霉素、磺胺甲噁唑/甲氧苄啶、罗红霉素的耐药株数较多,对呋喃妥因、米诺环素的耐药株数较少,未检出对万古霉素、替考拉宁或利奈唑胺耐药的菌株。主要革兰阴性菌对头孢唑林、阿莫西林、磺胺甲噁唑/甲氧苄啶、氨苄西林的耐药株数较多,对头孢哌酮/舒巴坦、阿米卡星的耐药株数较少,未检出对美罗培南和亚胺培南耐药的菌株。多因素Logistic回归分析结果显示,机械通气时间较长、气管插管或切开、合并糖尿病是颅脑外伤昏迷患者VAP发生的独立相关因素(P<0.05)。结论引发颅脑外伤昏迷患者VAP的病原菌以革兰阴性菌居多,金黄色葡萄球菌、铜绿假单胞菌、鲍氏不动杆菌是常见病原菌,其发生风险与治疗因素、合并基础疾病有关,临床医师应给予高度关注、及时干预和有效治疗,努力提升医院感染的预防和控制效果。OBJECTIVE To investigate the distribution of pathogens isolated from the craniocerebral trauma and coma patients with ventilator-associated pneumonia(VAP) and analyze the related factors so as to provide guidance for prevention and control of nosocomial infection. METHODS A total of 222 patients with craniocerebral trauma and coma who were treated in the hospital from Jul 2016 to Jul 2018 were recruited as the study objects.The incidence of VAP, distribution of pathogens and related factors were retrospectively analyzed. RESULTS Of the 222 patients with craniocerebral trauma and coma, 78 had VAP, with the incidence rate of 35.14%.The pathogens were isolated from sputum specimens of 65 patients, with the isolation rate 83.33%.Totally 77 strains of pathogens were isolated, 35(45.45%) of which were gram-positive bacteria, 37(48.05%) were gram-negative bacteria, and 5(6.49%) were fungi;Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of the gram-positive bacteria;Pseudomonas aeruginosa and Acinetobacter baumannii were dominant among the gram-negative bacteria;Candida albicans was the predominant species of the fungi.Among the major species of the gram-positive bacteria, there were a large number of strains that were resistant to penicillin G, erythromycin, sulfamethoxazole-trimethoprim and roxithromycin and few strains that were resistant to nitrofurantoin and minocycline, while, no strains that were resistant to vancomycin, teicoplanin or linezolid were found.Among the major species of the gram-negative bacteria, there were a large number of strains that were resistant to cefazolin, amoxicillin, sulfamethoxazole-trimethoprim and ampicillin and few strains that were resistant to cefoperazone-sulbactam and amikacin, while, no strains that were resistant to meropenem or imipenem were found.The result of multivariate logistic regression analysis showed that the long time of mechanical ventilation, endotracheal intubation or tracheotomy and complication with diabetes mellitus were the ind

关 键 词：颅脑外伤 昏迷 呼吸机相关性肺炎 病原菌分布 相关因素 

分 类 号：R651.1[医药卫生—外科学]