重型颅脑外伤患者并发下呼吸道感染的菌群及耐药分析

The Study of the Flora and Their Drug Resistance from Patients with Severe Traumatic Brain Injury and Lower Respiratory Tract Infection

目的了解重型颅脑外伤患者并发下呼吸道感染的菌群分布及耐药性,为临床治疗提供有效的依据。方法从83例下呼吸道感染患者痰标本中分离出致病菌249株,对249株细菌纸片扩散法(KB法)行药敏测定分析。结果下呼吸道感染病原菌以革兰阴性菌为主,占67.9%,主要为铜绿假单胞、大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、阴沟肠杆菌、嗜麦芽寡养单胞菌;革兰阳性菌占18.1%,主要为金黄色葡萄球菌、表皮葡萄球菌,粪肠球菌、肺炎链球菌;真菌占9.6%,主要为白念珠菌。大多数革兰阴性菌对亚胺培南较敏感,青霉素类、氨曲南、左氧氟沙星均有不程度的耐药。革兰阳性菌对万古霉素敏感,对其他抗菌药物有不同程度的耐药。结论革兰阴性杆菌是构成下呼吸道感染的主要致病菌,细菌耐药性明显增强,出现多重耐药菌,应该提倡科学地、合理地应用抗菌药物。

Objective Understanding of patients with severe traumatic brain injury flora distribution of lower respiratory tract infection and drug resistance,to provide an effective basis for clinical treatment.Methods From 83 patients with lower respiratory tract infection pathogens isolated from sputum samples 249,249 strains of bacteria by disk diffusion method（KB method） line determination of drug susceptibility.Results Lower respiratory tract infection pathogens in gram-negative bacteria,accounting for 67.9%,mainly P.aeruginosa,Escherichia coli,Klebsiella pneumoniae,Acinetobacter spp,Enterobacter cloacae,Stenotrophomonas oligotrophic single intracellular bacteria;Gram-positive bacteria accounted for 18.1%,mainly Staphylococcus aureus,Staphylococcus epidermidis,Enterococcus faecalis,Streptococcus pneumoniae;fungi 9.6%,mainly Candida albicans.Most gram-negative bacteria more sensitive to imipenem,penicillins,aztreonam,levofloxacin resistance were not level.Gram-positive bacteria sensitive to vancomycin to other antibiotics with different degrees of resistance.Conclusion Gram-negative bacteria constitute the major pathogens of lower respiratory tract infection,significantly increased bacterial resistance,there multidrug resistant,should promote a scientific and rational application of antibiotics.