重症颅脑损伤患者肺部感染病原菌分析

Pathogens causing pulmonary infections in patients with severe craniocerebral injuries

目的探讨重症颅脑损伤ICU内肺部感染病原菌检验分析的临床应用,为其临床研究提供参考依据。方法选取86例因重症颅脑损伤入住医院ICU且发生肺部感染的患者,所有患者均详细记录基本信息,根据病情给予相应治疗,同时留取其痰液进行培养及药敏试验;采用SPSS12.0软件进行统计分析。结果 86例患者中共分离出病原菌94株,其中革兰阴性菌55株占58.5%,以肺炎克雷伯菌为最多,革兰阳性菌29株占30.9%,以金黄色葡萄球菌最多,真菌10株占10.6%,以白色假丝酵母菌最多;革兰阴性菌对头孢哌酮/舒巴坦最敏感,敏感率80.0%,其次为亚胺培南,敏感率74.5%;革兰阳性菌对万古霉素最敏感,敏感率96.6%,其次为氨苄西林,敏感率82.8%,真菌对氟康唑最敏感,敏感率80.0%,其次为伏立康唑,敏感率60.0%。结论重症颅脑损伤患者肺部感染应尽早采集标本进行细菌鉴定及药敏试验,明确病原学诊断,有针对性地使用敏感的抗菌药物。

OBJECTIVE To explore the distribution of pathogens causing pulmonary infections in ICU patients with severe craniocerebral injuries so as to provide bases for clinical study.METHODS Totally 86patients who were hospitalized for severe craniocerebral injuries and complicated with pulmonary infections were enrolled in the study,then the basic information of all the patients was recorded in detail,the corresponding therapies were performed according to the condition,the sputum specimens were sampled for culture,the drug susceptibility testing was carried out,and the statistical analysis was performed with the use of SPSS12.0software.RESULTS A total of 94 strains of pathogens have been isolated from the 86patients,including 55（58.5%）strains of gram-negative bacteria,29（30.9%）strains of gram-positive bacteria,and 10（10.6%）strains of fungi;the Klebsiella pneumoniae was dominant among the gram-negative bacteria,the Staphylococcus aureus was the predominant species of the gram-positive bacteria,and the Candida albicans was the most common species of the fungi.The gram-negative bacteria were most susceptible to cefoperazone-sulbactam with the susceptibility rate of 80.0%,followed by imipenem（74.5%）;the gram-positive bacteria were most susceptible to vancomycin with the susceptibility rate of 96.6%,followed by ampicillin（82.8%）;the fungi were the most susceptible to fluconazole with the susceptibility rate of 80.0%,followed by voriconazole（60.0%）.CONCLUSIONIt is necessary to collect specimens from the severe craniocerebral injuries patients with pulmonary infections for bacterial identification and drug susceptibility testing in a timely manner,define the etiological diagnosis,and reasonably use susceptible antibiotics.