神经外科老年患者术后医院感染病原菌分布及耐药性监测

Distribution and drug resistance of pathogens causing postoperative nosocomial infections in elderly patients of department of neurosurgery

目的研究分析神经外科老年患者术后医院感染的病原菌分布并监测其耐药性,提高临床对神经外科老年手术患者的治疗水平。方法选取2011年1月-2013年1月入院治疗的神经外科术后医院感染的老年患者180例,采集感染者的脓液、尿液、切口分泌物、痰液等进行细菌培养、革兰染色等鉴定菌种,采用纸片扩散法,进行药敏试验,对病原菌进行耐药性检测,数据采用SPSS 16.0进行分析。结果 180例患者共分离出263株病原菌,检出最多的是铜绿假单胞菌62株占23.57%,其次为肺炎克雷伯菌40株占15.21%、大肠埃希菌37株占14.07%、酵母样真菌29株占11.03%;革兰阴性菌对头孢哌酮/舒巴坦、阿米卡星、亚胺培南、左氧氟沙星耐药率较低,分别为12.90%、19.35%、12.90%、38.71%,革兰阳性菌对万古霉素、呋喃妥因耐药率较低,分别为0、5.00%。结论医院感染部位多集中在呼吸道、消化道部位,病原菌以铜绿假单胞菌、洋葱假单胞菌、肺炎克雷伯菌、大肠埃希菌等,并且常见抗菌药物的耐药现象较为严重,临床上应及时调整用药方针并采取相应预防措施。

OBJECTIVE To study the distribution and drug resistance of pathogens causing postoperative nosocomial infections in elderly patients of department of neurosurgery so as to improve the level of clinical treatment. METHODS A total of 180 elderly patients with postoperative nosocomial infections, who were hospitalized the department of neurosurgery from Jan 2011 to Jan 2013, were enrolled in the study, then the pus, urine, wound secretions, and sputum were collected for the bacteriai culture, the species of isolated bacteria were identified by using Gram staining, the drug susceptibility testing was performed with the use of disk diffusion method, the drug resistance of the pathogens was analyzed, and the data were statistically analyzed by means of SPSS 16.0 soft- ware. RESULTS Totally 263 strains of pathogens have been isolated from the 180 patients, among which there were 62 （23. 57%） strains of Pseudomonas aeruginosa, 40 （15. 21%） strains of Klebsiella pneumoniae, 37 （14.07 %） strains of Escherichia coli, and 29 （11.03 %） strains of yeast-like fungi. The drug resistance rates of the gram-negative bacteria to cefoperazone-sulbactam, amikacin, imipenem, and levofloxacin were 12. 90%, 19.35%, 12.90%, and 38.71%, respectively. The drug resistance rates of the gram-positive bacteria to vanco- mycin and nitrofurantoin were 0 and 5.00 %, respectively. CONCLUSION The respiratory tract and gastrointesti- nal tract are the common nosocomial infection sites. The P. aeruginosa, Pseudomonas cepacia, K. pneumoniae, and E. coli are the predominant species of pathogens and are highly resistant to the commonly used antibiotics. It is necessary for the hospital to adjust the medication principles in a timely manner and take targeted prevention measures.