重型颅脑损伤气管切开患者肺部感染的病原菌分析

Pathogens analysis causing pulmonary infections after tracheotomy in patients with severe craniocerebral injury

目的通过对重型颅脑损伤患者气管切开后发生肺部感染的临床及细菌学研究,探讨病原菌分布及耐药现状分析,以指导临床治疗及合理用药、提高治疗效果。方法回顾性调查2005年5月-2013年3月45例重型颅脑损伤行气管切开后发生肺部感染患者临床资料,对临床治疗、痰培养及药物敏感性试验结果进行统计分析,用VITEK-2Compact全自动微生物鉴定系统进行菌种鉴定和药敏试验。结果共分离出238株病原菌,革兰阴性菌226株占95.0%,革兰阳性菌12株占5.0%;革兰阴性菌对亚胺培南的药物敏感性最高,达到63.8%;12株革兰阳性菌对万古霉素100.0%敏感,对喹奴普汀/达福普汀的敏感率也在50.0%以上。结论重型颅脑损伤行气管切开并发肺部感染以革兰阴性菌为主,临床治疗中必须根据药敏检测结果及时调整用药,加强抗菌药物规范使用,减少耐多药病原菌的增加;综合规范的护理措施也对减少肺部并发症起到积极的作用。

OBJECTIVE Through clinical and bacteriological analysis of pulmonary infections after tracheotomy in patients with severe craniocerebral injury, to explore the distribution and drug resistance of pathogens to guide clinical medication and enhance the treatment effect. METHODS The results of sputum culture and drug sensitivity test of 4：5 cases of pulmonary infections after tracheotomy in patients with severe craniocerebral injury from May. 2005 to Mar. 2013 and their clinical data were analyzed retrospectively. The VITEK-2 Compact fully automatic microbial identification system was used for pathogen identification and drug sensitivity test. RESULTS A total of 238 strains of pathogens were isolated. The 226 strains of gram-negative bacteria occupied 95. 0%, with the highest drug sensitivity to imipenem （63.8 %）. Totally 12 strains of gram-positive bacteria （accounting for 5.0%） showed a sensitivity of 100. 0% to vancomycin and over 50. 0% to quinupristin/ddalfopristin. CONCLUSION Pulmonary infection after tracheotomy in patients with severe craniocerebral injury was mainly caused by gramnegative bacteria. It is important to adjust timely antibiotics based on drug sensitivity test and use reasonably antibiotics so as to reduce the multidrug-resistant pathogen strains. Comprehensive correctly nursing measures also play a positive role in reducing pulmonary complications.