重型颅脑损伤患者气管切开后并发肺部感染的病原菌及药敏试验分析-东南大学学报医学版

重型颅脑损伤患者气管切开后并发肺部感染的病原菌及药敏试验分析

单位：安徽医科大学解放军临床学院, 解放军105医院神经外科, 安徽合肥 230031

分类号：R651.1

出版年·卷·期（页码）：2019·38·第一期（88-92）

摘要：

目的：探究重型颅脑损伤患者气管切开后并发肺部感染的病原菌分布特点及药敏试验结果，为临床规范用药提供依据。方法：选取2014年5月至2017年5月本院收治的重型颅脑损伤患者450例为研究对象。分析患者行气管切开后并发肺部感染的呼吸道分泌物细菌培养及药敏试验结果。结果：450例患者并发肺部感染60例（13.33%）。培养出254株病原菌，其中革兰阳性菌33株（12.99%），革兰阴性菌205株（80.71%），真菌16株（6.30%）。革兰阳性菌中，以金黄色葡萄球菌（21株）占比（8.27%）居高；革兰阴性菌中，占比以铜绿假单胞菌（74株，29.13%）、鲍氏不动杆菌（53株，20.87%）、肺炎克雷伯菌（47株，18.50%）居高。药敏结果显示，金黄色葡萄球菌相对敏感的抗菌药物为万古霉素、复方新诺明；主要革兰阴性菌对抗菌药物亚胺培南、头孢呱酮/舒巴坦的敏感率均相对高，其中铜绿假单胞菌敏感率分别94.59%、87.84%，鲍氏不动杆菌90.57%、81.13%，肺炎克雷伯菌93.62%、82.98%。结论：革兰阴性菌是重型颅脑损伤患者行气管切开并发肺部感染的主要病原菌，临床应强化病原菌培养及药敏监测，以指导抗菌药物合理应用，防止耐多药病原菌增加。

Objective:To investigate the pathogenic bacteria distribution characteristics and drug susceptibility among patients with severe craniocerebral trauma complicated with pulmonary infection after tracheotomy, so as to provide basis for clinical standard medication. Methods:A total of 450 patients with severe craniocerebral injury admitted to our hospital from May 2014 to May 2017 were selected as study subjects. Bacteria were cultured and drug susceptibility test were performed in patients with respiratory secretions after pulmonary tracheotomy after tracheotomy. Results:There were 60 patients (13.33%) with pulmonary infection in 450 patients.254 strains of pathogenic bacteria were cultured, including 33 strains (12.99%) of gram-positive bacteria, 205 strains (80.71%) of gram-negative bacteria, and 16 strains (6.30%) of fungi.Among Gram-positive bacteria, the proportion of Staphylococcus aureus (21 strains) was higher (8.27%).Among Gram-negative bacteria, P. aeruginosa (74 strains, 29.13%), Acinetobacter baumannii (53 strains, 20.87%), and Klebsiella pneumoniae (47 strains, 18.50%) were higher. Drug susceptibility results showed that the relatively sensitive antibacterial agents of Staphylococcus aureus were vancomycin and compound sulfamethoxazole. The susceptibility rates of major gram-negative bacteria to antimicrobial agents imipenem and cefoperazone/sulbactam were relatively high. To them, the sensitivity rates of Pseudomonas aeruginosa were 94.59% and 87.84%, Acinetobacter baumannii 90.57% and 81.13% respectively, and Klebsiella pneumoniae 93.62% and 82.98%. Conclusion:Gram-negative bacteria is the main pathogen of tracheotomy complicated with pulmonary infection in patients with severe traumatic brain injury. It is necessary to strengthen the culture of pathogens and drug sensitivity monitoring to guide the rational use of antimicrobial agents and prevent the increase of multi-drug resistant pathogens.

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