神经外科下呼吸道感染患者支气管肺泡灌洗液病原学分析

The Etiological Analysis of Bronchoalveolar Lavage in Neurosurgical Patients with Respiratory Tract Infection

目的了解神经外科并下呼吸道感染患者病原菌构成及药物敏感性。方法 2009年8月～2010年8月,对重症监护病房(ICU)38例因颅脑损伤并下呼吸道感染患者进行纤维支气管镜支气管肺泡灌洗(bronchoalveolar lavage by bronchofibroscopy,BAL)检查,灌洗液送细菌培养及药敏试验。结果 38例患者BAL细菌培养均为阳性,阳性率100%,分离率居前三位的分别为铜绿假单胞菌、肺炎克雷伯菌、鲍曼氏不动杆菌;药敏结果显示各类细菌对常用抗菌素严重耐药。结论神经外科合并下呼吸道感染的病原菌以革兰氏阴性杆菌,病原菌耐药率高,根据本地区病原菌分布及耐药情况合理选用抗菌药物对临床疗效有重要价值。

Objective To comprehend the constitution and drug sensitivity of pathogenic bacteria in neurosurgical patients with lower respiratory tract infection. Methods 38 cases of brain injury with respiratory tract infection patients in ICU from August 2009 to August 2010 received the bronchoalveolar lavage by flbrobronchoscopy examination, and the lavage fluid received the bacteria culture and drug sensitive test. Results The bacterial culture of BAL in 38 cases were positive, the positive rate was 100%; the top three of isolation rate were pseudomonas aeruginosa, klebsiella pneumonia and acinetobacter baumannii; the drug sensitive test showed that all kinds of bacteria were serious resistance to common antibiotics. Conclusion Gram-negative bacteria with a high rate of multi-drug resistance are the main cause of respiratory tract infections in the neurosurgery depamnent. Rational selection of antibiotics based on the pathogenic bacteria＇s area distribution and drug resistance has an important value to the clinical efficacy.