NICU脑出血气管切开患者肺部感染病原菌分布与耐药性分析

Distribution and drug resistance of pathogens causing pulmonary infections in NICU intracerebral hemorrhage patients undergoing tracheotomy

目的分析神经外科重症监护病房(NICU)高血压脑出血气管切开患者肺部感染的病原菌分布及其耐药性,为临床合理选取抗菌药物预防和治疗肺部感染提供指导。方法收集2013年8月-2015年8月NICU收治的79例高血压脑出血气管切开患者的痰标本进行培养,分析病原菌及其耐药性。结果 79例患者送检痰标本共培养病原菌223株,其中革兰阴性菌167株占74.89%,以肺炎克雷伯菌为主占30.49%,其次为铜绿假单胞菌占17.94%;革兰阳性菌56株占25.11%,以金黄色葡萄球菌为主占15.25%;革兰阴性菌对头孢曲松、哌拉西林的耐药率均>55.00%,革兰阳性菌对氨苄西林、夫西地酸、头孢唑林、苯唑西林的耐药率均>97.00%。结论革兰阴性菌、革兰阳性菌分别是NICU高血压脑出血患者气管切开术后肺部感染常见的病原菌,且其耐药性强,临床应合理选择抗菌药物进行有效治疗。

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing pulmonary infections in neurosurgery intensive care unit（NICU）hypertensive cerebral hemorrhage patients undergoing tracheotomy so as to provide guidance for reasonable clinical use of antibiotics and treatment of the pulmonary infections.METHODS The sputum culture was carried out for 79 NICU hypertensive intracerebral hemorrhage patients who underwent the tracheotomy from Aug 2013 to Aug 2015,and the distribution and drug resistance of the pathogens were observed.RESULTS A total of 223 strains of pathogens were isolated from the submitted specimens that were obtained from the 79 patients,including 167（74.89%）strains of gram-negative bacteria and 56（25.11%）strains of gram-positive bacteria;the Klebsiella pneumoniae and Pseudomonas aeruginosa were the major species of the gram-negative bacteria,accounting for 30.49% and 17.94%,respectively;Staphylococcus aureus was the predominant species of the gram-positive bacteria,accounting for 15.25%.The drug resistance rates of the gramnegative bacteria to ceftriaxone and piperacillin were more than 55.00%;the drug resistance rates of the grampositive bacteria to ampicillin,fusidic acid,cefazolin,and oxacillin were more than 97.00%.CONCLUSION The gram-negative bacteria and gram-positive bacteria are the common pathogens causing the postoperative pulmonary infections in the NICU hypertensive intracranial hemorrhage patients undergoing the tracheotomy and are highly resistant to the antibiotics;it is necessary for the hospital to reasonably use antibiotics for the treatment.