重度颅脑损伤患者并发肺部感染的病原菌及耐药性研究

Pathogens and Drug Resistance in Patients of Severe Craniocerebral Injury Combined with Pulmonary Infection

目的：观察重度颅脑损伤患者并发肺部感染的病原菌特点及耐药性，为临床诊治提供参考依据。方法：对我院2010年2月-2012年2月收治的62例重度颅脑损伤患者的病例资料进行回顾性分析，观察其病原菌分布特点及药敏检查结果。结果：重度颅脑损伤患者62例，发生肺部感染者28例，肺部感染发生率45．16％。共分离病原菌31株，其中革兰阴性杆菌21株，占67．74％；革兰阳性球菌6株，占19．35％；真菌4株，占12．9％。经药敏试验分析，革兰阴性杆菌对亚胺培南高度敏感；革兰阳性球菌对利福平、万古霉素、呋喃妥因高度敏感。经单因素分析，气管切开操作史、住院天数延长、基础疾病、休克、呼吸机使用均是导致重度颅脑损伤发生肺部感染的危险因素（P〈0．05）。结论：重度颅脑损伤患者并发肺部感染病原菌以革兰阴性杆菌为主，临床发生率较高，针对病原菌特点采用敏感抗生素对提高治疗效果具有重要作用。

Objective： To observe the characteristics of pathogens and drug resistance in patients of severe craniocerebral injury combined with pulmonary infection, provide the references for clinical diagnosis and treatment. Methods： A retrospective analysis was carried on the 62 severe craniocerebral injury patients who were admitted in our hospital between February 2010 and February 2012, and the distribution of pathogens and drug sensitivity characteristics of inspection were analyzed. Results： In 62 patients with severe craniocerebral injury, pulmonary infection were found in 28 cases, the rate of pulmonary infection was 45.16%. A total of 31 strains of pathogens were isolated, including 21 strains of gram negative bacilli, accounting for 67.74%; 6 strains of gram positive coccus, accounting for 19.35%; 4 strains of fungi, accounted for 12.9%. By the analysis of drug susceptibility test, gram negative bacilli were highly sensitive to imipenem; gram positive cocci to rifampin, vancomycin, nitrofurantoin, highly sensitive, univariate analysis, tracheotomy operation history, the length of hospitalization, underlying diseases, shock, the use of respirator were risk factors of severe brain injury combined with pulmonary infection （P〈0.05）. Conclusion： Gram-negative bacilli were the main infection pathogens of severe craniocerebral injury complicated by pulmonary, with high incidence rate. It is important to apply sensitive antibiotics, according to the characteristics of pathogenic bacteria to improve the therapeutic effect.