康复期脑外伤患者肺部感染病原菌分布及其耐药性

Distribution and drug resistance of pathogens causing lung infection in patients with brain trauma rehabilitation

目的探讨康复期脑外伤患者肺部感染的病原菌分布及其耐药性,为指导临床合理使用抗菌药物提供依据。方法收集2012年1月至2015年5月本院康复科收治的颅脑外伤合并肺部感染的460例患者下呼吸道分离的病原菌进行培养,药敏试验采用纸片扩散法,按照美国临床实验室标准化委员会标准判断结果。结果 460例康复期脑外伤患者中有80例发生肺部感染,感染率为17.39%;其中分离革兰阴性菌42株(占52.50%),革兰阳性菌31株(占38.75%);主要的革兰阴性菌依次为大肠埃希菌(14株)、肺炎克雷伯杆菌(12株)、铜绿假单胞菌(11株)和阴沟肠杆菌(3株)。革兰阳性菌以表皮葡萄球菌(17例)和金黄色葡萄球菌(9株)为主。另外分离真菌7株(占8.75%),其中光滑假丝酵母菌4株,白色假丝酵母菌2株,热带假丝酵母菌1株。多数病原菌对抗菌药物呈多药耐药性,革兰阴性菌对庆大霉素、阿米卡星、头孢他啶、头孢吡肟和环丙沙星耐药率较高(均>40.00%),革兰阳性菌对青霉素G、对氯霉素、红霉素、庆大霉素和妥布霉素耐药率较高(均>60.00%)。结论康复期脑外伤患者肺部感染的致病菌以革兰阴性菌为主,且对多种抗菌药物耐药,临床应加强对病原菌的分离和药敏分析,以指导临床合理使用抗菌药物,从而有效控制感染。

Objective To investigate the distribution and drug resistance of the pathogens causing lung infection in patients survived from brain trauma rehabilitation, and to provide evidence for reasonable use of antibiotics. Methods The pathogenic bacteria isolated from lower respiratory tract of 460 patients who rehabilitated from craniocerebral trauma complicated with pulmonary infection were collected from January 2012 to May 2015 in our hospital. The pathogenic bacteria were cultured and drug sensitivity test was performed by disk diffusion method, and the results were analyzed according to the National Committee for clinical laboratory standards standards. Results Among the 460 patients with traumatic brain injury rehabilitation, 80 cases were with pulmonary infection, the infection rate was 17.39%. Total of 42 strains （52.50%） of Gram negative bacteria were isolated, and 31 strains （38.75%） of Gram positive bacteria were isolated. The main Gram negative bacteria were Escherichia coli （14 strains）, Klebsiella pneumoniae （12 strains）, Pseudomonas aeruginosa （11 strains） and Enterobacter cloacae （3 strains）. The Gram positive bacteria were mainly Staphylococcus epidermidis （17 cases） and Staphylococcus aureus （9 strains）. In addition, 7 strains （8.75%） of fungi were isolated, among which 4 strains were smooth Candida, 2 strains were Candida albicans and 1 strains were Candida tropicalis. Most pathogens were multi-drug resistant to antibiotics, the rates of drug resistance for Gram negative bacteria to gentamicin, amikacin, ceftazidime, cefepime and ciprofloxacin were high （all 〉 40%）; the rates of drug resistance for Gram positive bacteria to penicillin G, erythromycin, gentamicin, chloramphenicol and tobramycin were all high （all 〉 60%）.Conclusions Gram-negative bacteria were the main bacteria causing lung infection in patients survived from brain trauma and underwent rehabilitation, all with multi-drug resistance. It was necessary to strengthen the separation of pathogens and drug-resistance analysis to direct the clinical rational use of antimicrobial agents and effective infection control.