NSICU肺部感染的临床调查

Clinical investigation of pulmonary infections in neurosurgical intensive care unit

目的对神经外科重症监护病房(NSICU)肺部感染病原菌种类及其耐药性进行分析,为NSICU肺部感染的预防和控制提供参考。方法运用回顾性分析的方法,对2006年8月-2010年8月入住医院NSICU有明确肺部感染患者的临床资料进行分析。结果肺部感染患者共检出病原菌173株,其中革兰阳性球菌38株,革兰阴性杆菌121株,真菌14株;居前5位的病原菌分别为金黄色葡萄球菌、鲍氏不动杆菌、肺炎克雷伯菌、铜绿假单胞菌及大肠埃希菌,分别占20.8%、16.8%、16.8%、16.2%、9.2%;金黄色葡萄球菌除对万古霉素(0)和磺胺甲噁唑/甲氧苄啶(11.1%)的耐药率较低外,对其余常用抗菌药耐药率均>45.0%,多数约90.0%;鲍氏不动杆菌对常用抗菌药物的耐药率已>65.0%;其余革兰阴性杆菌除对亚胺培南、头孢西丁耐药率较低外,对其他抗菌药物的耐药率均较高。结论 NSICU肺部感染病原菌已经呈现多药耐药性,应加强专科ICU建设和对肺部感染的认识,针对NSICU特点,控制肺部感染。

OBJECTIVE To study the species of pathogens causing pulmonary infections in neurosurgical intensive care unit （NSICU） and their drug resistance, so as to offer reference for the prevention and control of pulmonary infections in NSICU. METHODS A retrospective analysis of clinical data was performed for patients who were diagnosed pulmonary infections and enrolled in NSICU from Aug 2006 to Aug 2010. RESULTS Totally 173 strains of pathogens causing pulmonary infections were isolated, including 38 strains of gram-positive cocci, 121 strains of gram-negative bacilli, and 14 strains of fungi; the top 5 isolated pathogens were Staphylococcus aureus （20.8 %）, Acinetobacter baumannii （ 16. 8 %）, Klebsiella pneumoniae （16. 8 %）, Pseudomonas aeruginosa （ 16. 2 %）, and Escherichia coli （9.2 % ）, respectively; the drug resistance rates of S. aureus to all the antibiotics were higher than 45.0% （90.0% to the most） except vancomycin （0） and sulfamethoxazole/trimethoprim （11. 1%）; the drug resistance rates of A. baumannii to common antibiotics were higher than 65.0% ; the drug resistance rates of other species of gram-negative bacilli to all the antibiotics except imipenem and cefoxitin were relatively high. CONCLUSION The pathogens causing pulmonary infections in NSICU present as multidrug-resistant, it is necessary to emphasize on the recognition of pulmonary infections and the construction of NSICU according to the characteristics of NSICU so as to control pulmonary infections.