神经外科重型颅脑损伤患者肺部感染鲍曼不动杆菌的危险因素和耐药性分析

Analyses of Risk Factors and Antibiotic Resistance of Severe Craniocerebral Trauma Patients with Pulmonary Infection of Acinetobacter Baumannii of the Department of Neurosurgery

目的探讨神经外科患者重型颅脑损伤患者肺部感染鲍曼不动杆菌的危险因素和耐药状况,为临床预防和治疗提供依据。方法回顾性分析2012年1月—2015年12月神经外科收治的101例脑部术后继发肺部感染鲍曼不动杆菌患者的临床资料,调查相关危险因素,并采用纸片扩散法测定菌株对抗菌药物的敏感性,数据采用采用SPSS 20.0软件进行统计学分析。结果分析发现,糖尿病史、低蛋白血症、GCS评分、ICU住院天数、抗菌药物种数及累积用药天数、气管切开时间是肺部感染鲍曼不动杆菌的危险因素(P<0.01)。药敏结果显示,鲍曼不动杆菌对头孢哌酮钠/舒巴坦钠的敏感率最高,为71.34%,其次阿米卡星和亚胺培南,敏感率分别为55.41%和51.59%。结论神经外科患者重型颅脑损伤患者肺部感染鲍曼不动杆菌的危险因素较多,在临床工作中,应采取相应措施减少鲍曼不动杆菌感染的发生。鲍曼不动杆菌多重耐药严重,头孢哌酮钠/舒巴坦钠仍是敏感性最高的药物,其次是阿米卡星和亚胺培南,宜根据药敏试验结果选用。

OBJECTIVE To investigate the risk factors and analyses of antibiotic resistance of severe craniocerebral trauma patients with pulmonary infection of Acinetobacter baumannii of the department of neurosurgery, so as to provide references for clinical prevention and treatment. METHODS The clinical data of 106 patients of severe craniocerebral trauma patients with pulmonary infection of Acinetobacter baumannii from January 2011 to December 2015 were analyzed to investigate related risk factors, and the antimicrobial susceptibility was analyzed by disk diffusion method. The data were analyzed by SPSS 20.0 software. RESULTS The study showed that history of diabetes, low protein hyperlipidemia, GCS score, ICU hospital days, antibacterial drugs species and medication duration and ventilator assisted ventilation time were the risk factors for pulmonary infection of Acinetobacter baumannii（P〈0.01）. The antimicrobial susceptibility testing showed that cefoperazone sulbactam（71.34%） was the most active agents against Acinetobacter baumannii, followed by amikacin and imipenem, sensitivity rates respectively were 55.41% and 51.59%. CONCLUSION Many risk factors of pulmonary infection of Acinetobacter baumannii are found in department of neurosurgery of severe craniocerebral trauma patients. In clinical work, the corresponding measures should be taken to prevent or reduce the occurrence of pulmonary infection of Acinetobacter baumannii. Acinetobacter baumannii strains are highly resistant to multiple antibiotics. Cefoperazone sulbactam are still the most active agent against Acinetobacter baumannii, followed by amikacin and imipenem. Therapy should be decided according to the results of susceptibility test.