重型颅脑外伤气管切开患者下呼吸道感染的病原菌分布及耐药性分析

Analysis on the pathogenic bacteria distribution and drug resistance of lower respiratory tract infection in patients with severe traumatic brain injury after tracheotomy

目的分析重型颅脑外伤(sTBI)气管切开患者下呼吸道感染的病原菌分布及耐药性,为合理制订临床救治和抗感染治疗策略提供客观依据。方法选取2011年6月-2016年6月528例行气管切开的sTBI患者为研究对象,对其下呼吸道感染率、相关病原菌分布及耐药率进行研究和分析。结果 327例患者发生下呼吸道感染,感染率为61.9%;共分离出病原菌647株,革兰阴性菌、革兰阳性菌、真菌分别占78.5%、20.1%和1.4%,以铜绿假单胞菌、肺炎克雷伯菌、鲍氏不动杆菌、金黄色葡萄球菌的构成比最高,分别占30.0%、21.8%、19.0%和18.5%;在主要革兰阴性菌中,铜绿假单胞菌对氨曲南、庆大霉素、头孢派酮的耐药率较高均>60.0%,肺炎克雷伯菌对哌拉西林、头孢唑肟、头孢噻肟的耐药率较高均超过80.0%,鲍氏不动杆菌对所有受试抗菌药物的耐药率均>50.0%,其中,对头孢唑肟、头孢他定、头孢呋辛的耐药率均达100.0%,对氨苄西林、氨苄西林/舒巴坦的耐药率也均超过90.0%;在分离的金黄色葡萄球菌中,有87株为耐甲氧西林金黄色葡萄球菌(MRSA),检出率为72.5%,MRSA对头孢唑林、苯唑西林、青霉素G的耐药率均为100.0%,对左氧氟沙星、庆大霉素、红霉素、克林霉素的耐药率均>75.0%;有33株为甲氧西林敏感性金黄色葡萄球菌(MSSA)占27.5%,MSSA对青霉素G的耐药率较高为93.9%,而对其他抗菌药物的耐药率均较低。结论 sTBI气管切开患者下呼吸道感染的病原菌分布及耐药性具有一定的特征,可根据其病原学特征合理选取敏感性抗菌药物进行治疗,提高救治成功率、改善患者预后。

OBJECTIVE To analyze the pathogenic bacteria distribution and the drug resistance of lower respiratory tract infection in patients with severe traumatic brain injury（sTBI）after tracheotomy,so as to provide an objective basis for the scheming of reasonable anti infection treatment and clinical treatment strategy.METHODS A total of 528 cases of patients with sTBI after tracheotomy from Jun.2011 to Jun.2016 were selected as the research subjects.The incidence,the pathogenic bacteria distribution and the drug resistance of lower respiratory tract infection of the included patients were analyzed and studied.RESULTS Totally 327 cases were complicated with lower respiratory tract infection,and the infection rate was 61.9%.A total of 647 strains of pathogenic bacteria were isolated,and the gram-negative bacteria,gram-positive bacteria,and fungi accounted for 78.5%,20.1% and1.4%,respectively.The proportions of Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter baumannii and Staphylococcus aureus were the highest,accounting for 30%,21.8%,19% and 18.5%,respectively.In the gram-negative bacteria isolated, the resistant rates of Pseudomonas aeruginosa to gentamicin,aztreonam,and ceftazidime were higher,which were more than 60.0%.The resistant rates of K.pneumoniae to piperacillin,ceftizoxime,and cefotaxime were higher,which were more than 80.0%.The resistant rates of A.baumannii to all tested antimicrobial drugs were more than 50%,among them,the resistant rates to ceftizoxime,ceftazidime,and cefuroxime reached 100.0%,and the resistant rates of ampicillin,and ampicillin/sulbactam were higher,which were more than 90.0%.In the strains of S.aureus,87 strains were methicillin-resistant S.aureus（MRSA）strains,with the detection rate of 72.5%.The resistant rates of MRSA strains to cefazolin,oxacillin,and penicillin G reached 100.0%,and to levofloxacin,gentamicin,erythromycin,and clindamycin were more than 75%.Totally 33 strains were methicillin-sensitive Staphylococcus aureus（MSSA）strains,accounting for 27.5%.The resistant rate of such strains to penicillin G was higher,which was 93.9%,while the resistant rates to other antimicrobial drugs were lower.CONCLUSIONThe pathogenic bacteria distribution and the drug resistance of lower respiratory tract infection in the patients with sTBI after tracheotomy have certain features.The susceptible antimicrobial drugs should be employed reasonably according to the etiological characteristics in order to improve the success rate of treatment and the prognosis of patients.