神经外科患者术后下呼吸道感染病原学及肺炎克雷伯菌耐药基因检测  

Etiological characteristics of postoperative lower respiratory tract infections in patients of neurosurgery department and drug resistance genes in Klebsiella pneumoniae

作　　者：霍军丽 王毓 邓琪 王孟孟 张敏瑞 胡雪慧 HUO Jun-li;WANG Yu;DENG Qi;WANG Meng-meng;ZHANG Min-rui;HU Xue-hui(The First Affiliated Hospital of Air Force Military Medical University,Xi'an,Shaanxi 710032,China)

机构地区：[1]空军军医大学第一附属医院神经外科,陕西西安710032 [2]空军军医大学第一附属医院护理处,陕西西安710032

出　　处：《中华医院感染学杂志》2023年第7期1066-1070,共5页Chinese Journal of Nosocomiology

基　　金：陕西省提升公众科学素质计划项目[2020PSL(Y)089]。

摘　　要：目的探讨神经外科患者术后痰培养细菌耐药情况以及肺炎克雷伯菌耐药基因,为神经外科肺部感染患者经验性用药提供依据。方法选取2016年1月-2020年12月空军军医大学第一附属医院1331例神经外科下呼吸道感染患者送检的5362份痰标本,使用全自动细菌鉴定仪对术后痰液进行分离病原菌和鉴定,采用纸片扩散法分析其耐药性,并检测肺炎克雷伯菌耐药基因。结果5362份痰标本,共分离出病原菌4809株。其中革兰阳性菌1130株(23.50%),主要以金黄色葡萄球菌、纹带棒状杆菌、肺炎链球菌为主;革兰阴性菌3560株(74.03%),主要以鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌为主;真菌119株(2.47%)。革兰阳性菌对青霉素、克林霉素的耐药率较高,多数对万古霉素、利奈唑胺较敏感;革兰阴性菌对头孢唑林、头孢曲松、氨苄西林/舒巴坦、四环素的耐药率较高,多数对替加环素、黏菌素较敏感;碳青霉烯耐药肺炎克雷伯菌blaKPC、blaTEM、blaSHV、blaNDM、armA、rmtB耐药基因的检出率为83.58%、96.72%、90.45%、6.57%、11.04%、64.48%。结论神经外科患者术后下呼吸道感染的病原菌以革兰阴性菌为主,且整体耐药水平较高,尤其是部分肺炎克雷伯菌携带金属酶基因等,临床应根据药敏、耐药表型与基因检测及时调整用药。OBJECTIVE To identify postoperative drug-resistant spectrum of bacteria cultured from sputum,and to detect Klebsiella pneumoniae drug-resistant gene in neurosurgical patients.METHODS A total of 5362 sputum samples from 1331 patients with lower respiratory tract infections admitted in the First Affiliated Hospital of Air Force Military Medical University between Dec 2016 and Dec 2020 were enrolled.The pathogens were isolated and identified by full-automatic bacteria identification apparatus.The drug resistance of pathogens was detected by Kirby-Bauer method and drug resistance gene of K.pneumoniae was detected.RESULTS Among the 5362 sputum specimens of neurosurgery patients with lower respiratory tract infections,there were 4809 strains of pathogens,including 1130 strains of gram-positive bacteria(23.50%,mainly on Staphylococcus aureus,Corynebacterium striatum and Streptococcus pneumoniae),3560 strains of gram-negative bacteria(74.03%,mainly on K.pneumoniae,Pseudomonas aeruginosa and Acinetobacter baumannii)and 119 strains of fungi(2.47%).The main gram-positive bacteria were drug-resistant to penicillin and clindamycin,while they were sensitive to vancomycin and linezolid.The drug resistance rates of main gram-negative bacteria to cefazolin,cefatriaxone,ampicillin/sulbactam and tetracycline were high,while they were sensitive to tigecycline and colistin.The detection rates of carbapenem-resistant K.pneumoniae bla_(KPC),bla_(TEM),bla_(SHV),bla_(NDM),armA,and rmtB resistance genes were 83.58%,96.72%,90.45%,6.57%,11.04%,and 64.48%,respectively.CONCLUSION The pathogens of postoperative lower respiratory tract infections in neurosurgical patients are mainly gram-negative bacteria,and are highly drug-resistant,some of the K.pneumoniae strains carry with metalloenzyme genes.It is necessary for the hospital to adjust the medication based on the drug susceptibility testing,drug resistance phenotypes and gene test.

关 键 词：神经外科 下呼吸道感染 病原学 耐药性 术后感染 细菌谱 耐药分析 

分 类 号：R619.3[医药卫生—外科学]