神经外科重症监护室医院内感染调查分析

Investigation on nosocomial infection in ICU of Neurosurgery

目的了解脑外伤患者下呼吸道感染分离菌分布及其耐药情况,以利于有效预防及合理选用抗菌药物。方法用Phoenix-100全自动微生物分析仪进行鉴定及药敏试验。结果2006年1月至12月从脑外伤患者下呼吸道标本中分离出菌株74株,其中金黄色葡萄球菌占33.8%,肺炎克雷伯菌、大肠埃希菌分别占23.0%、12.2%。金黄色葡萄球菌对万古霉素的敏感率为100.0%,大肠埃希菌、肺炎克雷伯菌对亚胺培南的耐药率为零,而铜绿假单胞菌对亚胺培南耐药率达69.4%。25株金黄色葡萄球菌中耐甲氧西林金黄色葡萄球菌阳性率为88.0%,产β-内酰胺酶的阳性率达100.0%。肺炎克雷伯菌、大肠埃希菌产超广谱β-内酰胺酶(ESBLs)检出率分别为88.2%、66.7%。结论加强对神经外科重症监护室耐药菌株检测,合理使用抗菌药物,有效控制医院内感染。

Objective To investigate the distribution and resistance statue of bacteria isolated from lower respiratory tract in patients with brain trauma, so as to prevent lower respiratory infection effectively and select antibacterial agents rationally. Methods Bacteria identification and susceptibility tests were performed by Phoenix-100 automatic microorganism analyzer. Results From Jan to Dec 2006, 74 isolates were separated from lower respiratory tract specimens in patients with brain trauma. Staphylococcus aureus （S. aureus） accounts for 33.8%. Klebsiella pneumoniae （K. pneumoniae） and Escherichia coli （E. cold were 23.0% and 12.0% respectively. S. aureus were 100.0% sensitive to vancomycin. Imipenem showed powerful bactericidial activity against K. pneumoniae and E. coli with 100.0% of sensitivity. The resistance rate of Pseudomonas aeruginosa to imipenem accounted for 69.4%. Methicillin resistant staphylococcus aureus （MRSA） accounted for 88.0% in 25 strains of S. aureus, and all isolates produced β-lactamases. However, the detection rates of extended spectrum β- lactamases＇ （ESBL） produced K. pneumoniae and E. coli was 88.2% and 66.7% respectively. Conclusion It is concluded that surveillance on drug resistant strains should be intensified in ICU of Neurosurgery. Meanwhile, it is very important to use antimicrobials rationally for controlling nosocomial infections.