重型颅脑损伤合并蛛网膜下腔出血患者下呼吸道感染病原菌耐药性特征  

Pathogens and antibiotic resistance characteristics of lower respiratory tract infections in patients with severe traumatic brain injury combined with subarachnoid hemorrhage

作　　者：张李娟 洪莉勤 蔡琨 吴丽春 Zhang Lijuan;Hong Liqin;Cai Kun;Wu Lichun(Clinical Laboratory of the Third Hospital of Zhangzhou,Zhangzhou 363005,China)

机构地区：[1]漳州市第三医院检验科,漳州363005

出　　处：《实用医技杂志》2024年第9期661-664,共4页Journal of Practical Medical Techniques

摘　　要：目的分析重型颅脑损伤(STBI)合并蛛网膜下腔出血(SAH)患者下呼吸道感染病原菌、耐药性特征。方法选定本院2022年12月至2023年12月就诊的128例STBI合并SAH患者下呼吸道分泌物送检标本,进行痰培养、药敏试验,分析病原菌以及耐药性特征。结果128例STBI合并SAH患者下呼吸道感染分离出143株分离菌,革兰阳性菌有55株,占38.5%,其中金黄色葡萄球菌有40株,占27.97%;革兰阴性菌88株,占61.5%,其中肺炎克雷伯菌26株,占18.2%,铜绿假单胞菌20株,占14.0%,鲍曼不动杆菌29株,占20.3%。金黄色葡萄球菌对苯唑西林以及头孢西丁的耐药率均达到了70.0%;金黄色葡萄球菌对替加环素、万古霉素利奈唑胺的耐药性均为0。肺炎克雷伯菌对头孢曲松的耐药性较强,是53.8%,对左氧氟沙星、妥布霉素的耐药性较低,均是11.54%;铜绿假单胞菌对头孢曲松的耐药性较强,是85.0%,对哌拉西林/他唑巴坦的耐药性仅有5.0%;鲍曼不动杆菌耐药性较强的是头孢曲松,达到了79.3%,对复方新诺明的耐药性较低,是41.4%。结论肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、金黄色葡萄球菌是STBI合并SAH患者下呼吸道感染的主要病原菌,对头孢曲松的耐药率均较高,在疾病诊治过程中,临床应根据药敏试验,合理选用抗生素。Objective To analyze the pathogens and antibiotic resistance characteristics of lower respiratory tract infections in patients with severe traumatic brain injury(STBI)combined with subarachnoid hemorrhage(SAH).Methods We selected sputum samples from 128 patients with STBI combined with SAH who were treated at our hospital from December 2022 to December 2023.Perform sputum cultures and antibiotic susceptibility tests were performed to analyze the pathogens and their resistance characteristics.Results One hundred and forty-three strains of bacteria were isolated from lower respiratory tract infections in 128 patients with STBI combined with SAH.Among them,55 strains were Gram positive,accounting for 38.5%,and 40 strains were Staphylococcus aureus,accounting for 28.0%;88 strains were Gram negative bacteria,accounting for 61.5%,including 26 strains of Klebsiella pneumoniae,accounting for 18.2%,20 strains of Pseudomonas aeruginosa,accounting for 14.0%,and 29 strains of Acinetobacter baumannii,accounting for 20.3%.Staphylococcus aureus with resistance rates to oxacillin and cefoxitin reaching 70.0%.Staphylococcus aureus has low resistance to tigecycline,0 to vancomycin,and 0 to linezolid.Klebsiella pneumoniae has a strong resistance to ceftriaxone,accounting for 53.8%,while its resistance to levofloxacin and tobramycin is relatively low,both at 11.5%;Pseudomonas aeruginosa has a strong resistance to ceftriaxone at 85.0%,while its resistance to piperacillin/tazobactam is only 5.0%;The most resistant Acinetobacter baumannii is ceftriaxone,which accounts for 79.3%,while its resistance to compound sulfamethoxazole is relatively low,which is 41.4%.Conclusion Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,and Staphylococcus aureus are the main pathogens causing lower respiratory tract infections in STBI patients with SAH,and their resistance to ceftriaxone is relatively high.In the process of disease diagnosis and treatment,antibiotics should be selected reasonably based on drug sensitivity tests in cli

关 键 词：颅脑损伤 蛛网膜下腔出血 呼吸道感染 抗药性 细菌 抗药性 真菌 

分 类 号：R651.15[医药卫生—外科学] R743.35[医药卫生—临床医学] R446.5