304例脑外科术后医院获得性肺炎病原菌的分布及耐药性分析

The analysis of pathogen distribution and drug resistance on 304 cases of hospital acquired pneumonia postoperative of neurologic surgery

目的:监测脑外科术后医院获得性肺炎病原菌的分布及耐药性,为指导临床治疗提供依据。方法:对某院304例脑外科术后医院获得性肺炎患者的痰液标本进行分析,采用Microsan Work Away 40全自动细菌鉴定/药敏分析仪进行鉴定和药敏试验,运用WHO NET 5.6对药敏结果进行分析。结果:304例脑外科术后医院获得性肺炎患者自痰液中共分离病原菌326株,革兰阴性杆菌占68.71%,革兰阳性球菌占30.06%,分离率前5位的病原菌依次为鲍曼不动杆菌、金黄色葡萄球菌、肺炎克雷伯菌、铜绿假单胞菌和大肠埃希菌;耐药菌检出率从高到低依次为甲氧西林耐药金葡菌(MRSA)检出率为95.56%(86/90);鲍曼不动杆菌广泛耐药株检出率为58.33%(56/96);大肠埃希菌产ESBLs检出率为50%(6/12);肺炎克雷伯菌产ESBLs检出率为33.33%(6/20);铜绿假单胞菌广泛耐药株检出率为28.57%(8/28)。耐药菌患者发生前均有单药或两种预防性抗生素使用史。结论:脑外科术后医院获得性肺炎常见病原菌以革兰阴性杆菌为主,其次为革兰阳性球菌。多重耐药菌检出率较高。可能与预防性抗生素使用、术后免疫低下有关。必须加强预防性抗生素管理、耐药性监测,指导合理用药。

Objective：To Monitor the distribution and drug resistance of pathogenic bacteria in hospital acquired pneumonia postoperative of neurologic surgery, and to provide a guidline for clinical treatment.Methods：The sputum culture data of 304 cases hospital acquired pneumonia postoperative of neurologic surgery were analyzed by Microsan Work Away 40 automatic bacteria identification and drug sensitivity analyzer from Jan.2011 to Dec.2014.Results：A total of 326 strains of pathogens were isolated from 304 patients postoperative of neurologic surgery with hospital acquired pneumonia, among which 68.71% of them were gram-negative bacilli, and 30.06% were gram-postive coccus. The five leading causes of pathogenic bacteria were E.coli,Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli. The special bacteria of drug Resistant detection rate from high to low in turn were methicillin-resistant Staphylococcus aureus （detection rate 95.56%）,Bauman Acinetobacter pan drug resistant strain （detection rate 58.33%）,Escherichia coli with ESBLs （detection rate 50% ）, Klebsiella pneumonia bacteria producing ESBLs （detection rate 33.33%）,Pseudomonas aeruginosa strains of Pan drug Resistant （detection rate 28.57%）. At the same time, we find that there had been two Kinds or single drug for prophylactic antibiotic use in patients with special drug resistant bacteria.Conclusion：The common pathogenic bacteria in hospital acquired pneumonia postoperative of neurologic surgery were gram negative bacilli, whereafter followed by Gram positive cocci. The detection rate of muhidrug-resistant bacteria is higher.Bauman＇s Staphylococcus aureus,Escherichia coli, Acinetobacter drug resistance rate were all more than 50%, and Klebsiella pneumoniae, Pseudomonas aeruginosa amounted to about 30%,the situation is grim. Prophylactic antibiotic therapy,postoperative immunosuppression may be the reason. We must strengthen the management of prophylactic antibiotics, drug resistance monitoring,guiding rational drug use.