神经外科手术患者医院感染特点及病原菌耐药性分析

Characteristics of nosocomial infections caused by pathogens in neurosurgery department patients and analysis of drug resistance

目的分析神经外科手术患者医院感染特点及主要病原菌耐药性,为控制医院感染提供参考信息。方法对2010年1月-2011年12月神经外科手术患者进行前瞻性监测,定期总结分析反馈临床,提出干预对策。结果 1759例手术患者发生医院感染164例、196例次,感染率9.32%、例次感染率为11.14%;显著高于同期全院手术患者感染率1.43%(P<0.01);感染部位以下呼吸道为主,占52.55%,其次为颅内感染,占17.85%;共检出病原菌164株,以革兰阴性菌为主占76.05%,其次是革兰阳性菌占16.77%;病原菌前4位为鲍氏不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和金黄色葡萄球菌,分别占22.75%、15.57%、13.17%和8.98%;所选的抗菌药物中,对革兰阴性菌敏感性较高的有阿莫西林/克拉维酸、美罗培南、亚胺培南;对革兰阳性菌敏感性较高的药物有万古霉素、氯霉素、夫西地酸。结论加强手术患者及留置管道患者的全程管理,病原菌监测中重点关注感染者与带菌者消毒隔离措施的执行力,是减少医院感染多药耐药菌传播的重要环节。

OBJECTIVE To analyze the characteristics of nosocomial infections in the patients of neurosurgery departments and the drug resistance of the main pathogens so as to provide reference for the control of nosocomial infections.METHODS From Jan 2010 to Dec 2011,the prospective monitoring of the patients of the neurosurgery department was performed,the regular summaries,analysis and feedback to the hospital were carried out,the intervention countermeasures were put forward.RESULTS Of totally 1759 cases of patients investigated,nosocomial infections occurred in 164 patients（196 case-times） with the infection rate of 9.32%（the case-time infection rate of 11.14%,significantly higher than 1.43% of the patients of the whole hospital at the same period（P 0.01）;the lower respiratory tract was the main infection site,accounting for 52.55%,followed by the intracranial infections（17.85%）.Totally 164 strains of pathogens were isolated,including the gram-negative bacteria（76.05%） and the gram-positive bacteria（16.77%）,Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae and Staphylococcus aureus were the top four species of pathogens,accounting for 22.75%,15.57%,13.17%,and 8.98%,respectively.Of all the antibiotics tested,the gram-negative bacteria were highly susceptible to amoxicillin/clavulanic acid,meropenem,and imipenem,and the gram-positive bacteria were highly susceptible to vancomycin,chloramphenicol,and fusidic acid.CONCLUSION To strengthen the whole process management of the surgery patients and the indwelling catheterization patients and focus on the execution of the disinfection and isolation of the patients with infection and bacteria-carriers during the monitoring of pathogens is an effective way to prevent the spread of the multidrug-resistant bacteria.