开颅术后危重患者医院感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing nosocomial infections in critically ill patients after craniotomy

目的分析开颅手术后危重患者感染的病原菌分布及其耐药性,为临床控制术后感染提供参考依据。方法选取2012年6月-2016年6月医院行开颅手术患者584例,对发生术后颅内感染的52例患者进行细菌培养和药敏试验,分析感染患者的感染率、病原菌分布及其耐药性;采用法国生物梅里埃公司VITEK-2Compact全自动鉴定仪对菌株进行鉴定,采用纸片法进行药敏检测,采用SPSS19.0软件对数据进行统计分析。结果 584例开颅手术患者中52例患者发生术后颅内感染,感染率为8.9%;共分离出52株病原菌,其中革兰阴性菌36株,占69.2%,以肺炎克雷伯菌和鲍氏不动杆菌为主,分别占30.8%和26.9%,革兰阳性菌14株,占26.9%,以金黄色葡萄球菌和表皮葡萄球菌为主,均占11.5%,真菌2株,占3.9%;革兰阴性菌中鲍氏不动杆菌对头孢曲松耐药率最高,为78.6%,对环丙沙星耐药率最低,为21.4%,肺炎克雷伯菌对氨曲南及环丙沙星耐药率最高,为81.3%,对亚胺培南耐药率最低,为12.5%;革兰阳性菌中表皮葡萄球菌对青霉素耐药率最高,为100.0%,对万古霉素及利奈唑胺耐药率最低,为0,金黄色葡萄球菌对红霉素耐药率最高,为83.3%,对万古霉素及利奈唑胺耐药率最低,为0。结论开颅手术后有较高的感染风险,术后感染病原菌以革兰阴性菌为主,且革兰阴性菌对多种药物都具有耐药性,在术后治疗阶段需加强对病原菌的监控,从而进行有效干预,控制病原菌感染,保障患者预后。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing infections in critically ill patients after craniotomy so as to provide guidance for clinical control of postoperative infections.METHODS A total of 584 patients who underwent the craniotomy in hospitals from Jun 2012 to Jun 2016 were enrolled in the study.The bacterial culture and drug susceptibility testing were carried out for 52 patients with postoperative intracranial infections,and the infection rate and distribution and drug resistance of pathogens were analyzed.The isolated pathogens were identified by using VITEK-2 Compact automatic identification system of BioM＆#233;rieux,France,the drug susceptibility testing was conducted by means of disk method,and the statistical analysis of data was performed with the use of SPSS19.0 software.RESULTS Of the 584 patients who underwent the craniotomy,52 had the postoperative intracranial infections,with the infection rate 8.9 %.Totally 52 strains of pathogens were isolated,of which 36 （69.2%） were gram-negative bacteria,14 （26.9%） were gram-positive bacteria,and 2 （3.9 %） were fungi;Klebsiella pneumoniae and Acinetobacter baumannii were dominant among the gram-negative bacteria,accounting for 30.8 % and 26.9 %,respectively;Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of the gram-positive bacteria,accounting for 11.5% and 11.5%,respectively.Among the gram-negative bacteria,the drug resistance rate of the A.baumannii strains to ceftriaxone was the highest （78.6%）,the drug resistance rate to ciprofloxacin was the lowest （21.4%）;the drug resistance rate of the K.pneumoniae strains to aztreonam and ciprofloxacin was the highest （81.3%）,and the drug resistance rate to imipenem was the lowest （12.5 %）.Among the gram-positive bacteria,the drug resistance rate of the S.epidermidis strains to penicillin was the highest （100.0%）,the drug resistance rate to vancomycin and linezolid was the lowest （0）;the drug resistance rate of the S.aureus strains to erythromycin was the highest （83.3%）,and the drug resistance rate to vancomycin and linezolid was the lowest （0）.CONCLUSION The patients undergoing the craniotomy are at high risk of the postoperative infections,the gram-negative bacteria are dominant among the pathogens causing the postoperative infections and are resistant to a variety of antibiotics.It is necessary to strengthen the monitoring of pathogens during the treatment period so as to take effective intervention measures to control the infections.