颅脑外伤合并泌尿道感染患者的病原菌分布及耐药性分析

Analysis of pathogens distribution and drug resistance of traumatic brain injury patients with urinary tract infection

目的了解颅脑外伤合并泌尿道感染患者的病原菌分布及耐药性,为临床防治医院感染提供参考依据。方法对126例颅脑外伤合并泌尿道感染患者的实验室检验结果进行回顾性分析,考察泌尿道感染的诱因、病原菌种类及其药敏试验结果。结果造成泌尿道感染的主要原因是:留置导尿管、昏迷时间超过7 d、慢性基础性疾病、颅脑手术、泌尿道并发症。147株病原菌的类型主要为革兰阴性菌和真菌,构成比分别为46.26%和36.05%。菌种主要是大肠埃希菌(23.81%)、白色念珠菌(17.59%)、热带念珠菌(13.60%)、粪肠球菌(10.88%)、鲍曼不动杆菌(9.52%)、金黄色葡萄球菌(4.76%)、肺炎克雷伯菌(4.08%)。大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌对亚胺培南、美罗培南的敏感率均为100%,对头孢吡肟、头孢噻肟、阿米卡星、头孢西丁的耐药率较低,而对哌拉西林、头孢他啶、左氧氟沙星的耐药率较高。粪肠球菌、金黄色葡萄球菌对万古霉素、利奈唑胺的敏感率均为100%,而对青霉素、苯唑西林、庆大霉素的耐药率较高。白色念珠菌、热带念珠菌对两性霉素B的敏感率均为100%,而对氟康唑、伊曲康唑、伏立康唑有不同程度的耐药。结论通过监测病原菌的分布、变化及其药敏特点,可确立合理的抗菌药物应用方案,有利于控制颅脑外伤后泌尿道医院感染。

Objective To find out the pathogens distribution and drug resistance of traumatic brain injury patients with u- rinary tract infection; and to provide laboratory science basis for the prevention and control of hospital infections. Methods The microbiological culture samples test results of 126 cases of traumatic brain injury patients with urinary tract infection were analyzed retrospectively. Incentives, pathogens and antimicrobial susceptibility test results of urinary tract infection were investigated. Results The primary incentives of urinary tract infection were indwelling catheter, coma time exceeding 7 days, chronic underlying disease, craniocerebral operation and urinary tract complications. 147 pathogen- ic bacteria primarily were Gram-negative bacteria and fungi, the constituent ratio were 46.26% and 36.05%. Bacteria with high cogens were Escheriehia colt （ 23. 91% ）, Candida albicans （ 17.59% ）, Candida tropiealis （ 13.60% ）, Enterococcus faeealis（ 10.88% ） , Acinetobacter baumannii （ 9.52% ） , Staphylococcus aureus （ 4.76% ） and Klebsiella pneumoniae （4.08%）. Susceptibility rates of major Gram-negative bacteria to imipenem and meropenem were both 100% ;an- tibiotics with low resistance rates were cefepime, cefotaxime, amikacin and cefoxitin;antibiotics with high resistance rates were piperacillin, cefiazidime, levofloxacin. Susceptibility rates of major Gram-positive bacteria to vancomycin and linezolid were both 100% ;antibiotics with high resistance rates were penicillin, oxacillin and gentamicin. Susceptibility rates of ma- jor fungi to amphotericin B were both 100% ;antibiotics with different resistance rates were fluconazole, itraconazole and voriconazole. Conclusion By monitoring the distribution of pathogens, changes and susceptibility characteristics, rational antimicrohial application solutions can be established, and traumatic brain injury with urinary tract nosocomial infections can be controlled.