老年颅脑损伤患者气管切开后肺部感染的病原菌分布及药物敏感性分析  

Distribution of pathogenic bacteria and drug sensitivity of pulmonary infection after tracheotomy in elderly patients with craniocerebral injury

作　　者：程立仁[1] 项高波[1] 韩家密 丁东[1] 马灿[1] 张政伟 Cheng Liren;Xiang Gaobo;Han Jiami;Ding Dong;Ma Can;Zhang Zhengwei(Department of Neurosurgery,First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Hefei,Anhui,230031,P.R.China)

机构地区：[1]安徽中医药大学第一附属医院神经外科,安徽合肥230031

出　　处：《老年医学与保健》2022年第2期361-365,共5页Geriatrics & Health Care

摘　　要：目的分析老年颅脑损伤患者气管切开后肺部感染的病原菌分布与药物敏感性差异。方法回顾性分析2018年8月—2020年8月,安徽中医药大学第一附属医院神经外科重症监护室(NICU)与综合重症监护室(GICU)气管切开后发生肺部感染的老年颅脑损伤患者临床资料。评估患者的颅脑损伤程度和昏迷程度;记录基础疾病>2种的患者数、肺部感染前出现并发症的患者数、肺部感染前气管切开的时间以及ICU入住时间。对患者的痰液样本进行细菌培养和药敏试验。结果与GICU组比较,NICU组基础疾病>2种的患者数较少,肺部感染前气管切开的时间较长,ICU入住时间较短,差异均有统计学意义(P<0.05)。2组均以革兰氏阴性菌为主要病原菌,差异无统计学意义(70.91%vs 81.82%,P=0.178)。NICU组肺炎克雷伯菌多于GICU组,差异有统计学意义(P=0.025)。2组革兰氏阳性菌均以金黄色葡萄球菌最多见,差异无统计学意义(P>0.05)。肺炎克雷伯菌对头孢他啶耐药性较高;铜绿假单胞菌对替卡西林钠克拉维酸钾耐药性较高;鲍曼不动杆菌对头孢他啶和亚胺培南普遍耐药;金黄色葡萄球菌对青霉素G耐药性较高。2组病原菌耐药性差异无统计学意义(P>0.05)。结论革兰氏阴性菌可能是老年颅脑损伤患者气管切开并发肺部感染的主要病原菌。Objective To analyze the distribution of pathogenic bacteria and drug sensitivity of pulmonary infection after tracheotomy in elderly patients with craniocerebral injury.Methods The clinical data of elderly patients with craniocerebral injury who developed lung infection after tracheotomy in Neurosurgical Intensive Care Unit(NICU)and General Intensive Care Unit(GICU)of First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from August 2018 to August 2020 were retrospectively analyzed.The degree of craniocerebral injury and coma of the patients were evaluated;the number of patients with more than 2 kinds of basic diseases,the number of patients with complications before pulmonary infection,the time of tracheotomy before pulmonary infection,and the time of ICU stay were recorded.Bacterial culture and drug sensitivity tests were performed on sputum samples from the patients.Results Compared with GICU group,the number of patients with more than 2 kinds of basic diseases in NICU group was less,the time of tracheotomy before pulmonary infection was longer,and the stay time in ICU was shorter,the difference was statistically significant(P<0.05).Gram-negative bacteria were the main pathogenic bacteria in both groups,and there was no significant difference(70.91%vs 81.82%,P=0.178).The NICU group had more Klebsiella pneumoniae than the GICU group,and the difference was statistically significant(P=0.025).Staphylococcus aureus was the most common gram-positive bacteria in both groups,and the difference was not statistically significant(P>0.05).The resistance of Klebsiella pneumoniae to ceftazidime was high.Pseudomonas aeruginosa had high resistance to ticacillin sodium clavulanate potassium.Acinetobacter baumannii was generally resistant to ceftazidime and imipenem.Staphylococcus aureus was highly resistant to penicillin G.There was no significant difference in drug resistance between the two groups(P>0.05).Conclusion Gram-negative bacteria may be the main pathogenic bacteria of pulmonary infection aft

关 键 词：老年 颅脑损伤 肺部感染 病原菌 药物敏感性 

分 类 号：R651.15[医药卫生—外科学] R563.1[医药卫生—临床医学]