神经外科重症监护病房病原特点、耐药情况分析及对策

Pathogenic spectrum characters,drug-resistance analys is and preventions in neurosurgery intensive care unit

目的分析该院神经外科重症监护病房中气管切开或气管插管患者下呼吸道感染病原菌及耐药情况,以期指导临床合理用药。方法采用K-B法检测该院2001年1月至2004年12月间因行气管切开或气管插管的颅脑创伤患者而引发医院感染的353株致病菌的耐药性,并对相关危险因素进行回顾性调查分析。结果病原菌前5位依次为金黄色葡萄球菌85株(24·08%),肺炎克雷伯杆菌75株(21·25%),大肠埃希杆菌53株(15·01%),绿脓假单胞菌44株(12·46%),鲍氏不动杆菌40株(11·33%)。金黄色葡萄球菌对所有β内酰胺类及喹诺酮类抗生素耐药,对利福霉素类、氨基糖苷类及磷霉素的耐药率分别为2·5%、15·8%和20·5%;革兰阴性菌除了对第三四代头孢菌素类抗生素耐药性较低外(10·5%~56%),对其他β内酰胺类抗生素耐药性均较高(66·7%~98·1%);除鲍氏不动杆菌对哌拉西林/三唑巴坦耐药率较高(66·7%)外,其他病原菌对β内酰胺类+β内酰胺酶抑制剂敏感性均较高(2·5%~40%);对喹诺酮类抗生素的耐药性肺炎克雷伯菌较其他3种革兰阴性菌低(21·3%);近年铜绿假单孢菌对碳青霉烯类耐药率也在逐年增高(33·3%~35%)。结论神经外科重症监护病房病原菌分布和耐药性应引起重视,提高各个环节的有效控制水平并合理使用抗生素是神经外科重症监护病房预防下呼吸道感染的重要手段。作者单位:200235上海,复旦大学附属华山医院神经外科(胡锦、周良辅);上海第二医科大学市六临床医学院(姚海军);上海交通大学附属第六人民医院(徐涛、蒋燕群)

Objective To analyze the pathogenic spectrum and drug-resistance of the low respiratory tract who were trachea cut open or trachea intubated in neurosurgery intensive care unit,and to direct neurosurgery intensive care doctors to use antibiotics properly. Methods The drug-resistance of the 353 pathogenic spectrum were tested by kirby-bauer disk sensitivity method. All the patients were chosen from January 2001 to December 2004 who were trachea cut open or trachea intubaed,and also had a retrospective analysis of the related risk factors. Resuits The five infected pathogenic spectrum were as follows： 85 cases staphylococcus aureus （24.08 % ）, 75 cases klebsiella pneumoniae（ 21.25 % ）, 53 cases escherichia coli （ 15.01% ）, 44 cases pseudomonas aeruginosa （ 12.46 % ） and 40 cases acinetobacter baumannii （ 11. 33% ）. Staphylococcus aureus were all resistant to β-1actam and quinolones,1-,t the rates to rifampicin,aminoglycosides and fosfomycin were 2.5 % , 15.8 % and 20.5 %. Gram-negative bacteria were at a lower drug-resistance rates to the 3rd and 4th cephalosporins（ 10.5 % ～ 56 % ）, but higher drug-resistance rates to ^-lactam antibiotics; It was high rates for Acinetobacter baumannii to piperacillin/tazobactam （ 66.7 % ）, but sensitive to β-lactam/β-lactamases inhibitor combinations（2.5 % ～ 40 % ） ; Klebsiella pneumoniae were at lower drug-resistance rates to quinolones compared to other three bacteria（21.3% ）. The rates of Pseudomonas aeruginosa to carbonpenems were increasing in recent years （33.3 %～ 35 % ）. Conclusion Neurosurgery intensive care unit doctors should pay much attention to the pathogenic spectrum and their drug-resistance,and it is important to enhance monitoring level and to use antibiotics properly in preventing lower respiratory tract infections.