2012—2016年鄂州市中心医院重度颅脑损伤并发肺部感染病原菌的分布及其耐药性分析

Analysis on distribution and drug resistance of pathogenic bacteria from patients with severe craniocerebral injury complicated with pulmonary infection in Ezhou Central Hospital from 2012 to 2016

目的了解鄂州市中心医院重度颅脑损伤并发肺部感染病原菌的分布及其耐药性。方法收集2012—2016年鄂州市中心医院重度颅脑损伤并发肺部感染患者(378例)的临床资料,对其感染病原菌的分布、感染类型及耐药性进行分析。结果 378例患者中共分离出病原菌611株,革兰阴性菌448株(67.78%),革兰阳性菌201株(30.41%),真菌12株(1.82%)。378例患者中,126例(33.33%)分离出单一病原菌,主要为铜绿假单胞菌、金黄色葡萄球菌、鲍曼不动杆菌等;221例(58.46%)分离出两种病原菌,主要为铜绿假单胞菌+鲍曼不动杆菌、大肠埃希菌+肺炎克雷杆菌、鲍曼不动杆菌+大肠埃希菌;31例(8.20%)分离出三种病原菌,主要为鲍曼不动杆菌+肺炎链球菌+白色念珠菌、肺炎克雷杆菌+阴沟肠杆菌+溶血性葡萄球菌、鲍曼不动杆菌+肺炎克雷杆菌+大肠埃希菌。药敏结果显示,革兰阴性菌对大部分抗菌药物耐药,鲍曼不动杆菌对头孢哌酮钠舒巴坦、阿米卡星的耐药率较低,铜绿假单胞菌、大肠埃希菌、肺炎克雷伯杆菌等对亚胺培南、美罗培南、头孢他啶和头孢哌酮钠舒巴坦的耐药率较低;革兰阳性菌对万古霉素、替考拉宁、利奈唑胺的耐药率低。结论重度颅脑损伤并发肺部感染病原菌以革兰阴性菌混合感染为主,药敏提示对大多数抗菌药物耐药。临床治疗中应加强临床病原菌的监测,合理选用抗菌药物、及时控制感染。

Objective To understand the distribution and drug resistance of pathogenic bacteria from patients with severe craniocerebral injury complicated with pulmonary infection in Ezhou Central Hospital. Methods The clinical data of patients（378 cases） with severe craniocerebral injury complicated with pulmonary infection in Ezhou Central Hospital from 2012 to 2016 were enrolled. The pathogen distribution, infection type, and drug resistance were analyzed. Results There were 661 strains of pathogens identified in 378 patients, including 448 strains of Gram-negative bacteria（67.78%）, 201 strains of Gram-positive bacteria（30.41%）, and 12 strains of Fungi（1.82%）. There were 126 patients（33.33%） who identified one pathogen in 378 patients, mainly Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii and so on; and 221 patients（58.46%） identified two pathogens, mainly P. aeruginosa ＋ A. baumannii, Escherichia coli ＋ Klebsiella pneumoniae, A. baumannii ＋ E. coli; and 31 patients（8.20%） identified three pathogens, mainly A. baumannii ＋ Streptococcus pneumoniae ＋ Candida albicans, K. pneumoniae ＋ Enterobacter cloacae ＋ Staphylococcus haemolyticus, A. baumannii ＋ K. pneumoniae ＋ E. coli. Drug sensitivity showed that Gram-negative bacteria were resistant to most antimicrobial agents. A. baumannii was the less resistant to cefoperazone/sulbactam and amikacin. The drug resistance rate of P. aeruginosa, E. coli, and K. pneumoniae against imipenem, meropenem, ceftazidime, and cefoperazone/sulbactam was lower. The drug resistance rate of Gram-positive bacteria against vancomycin, teicoplanin, and linezolid was lower. Conclusion Severe craniocerebral injury complicated with pulmonary infection is mainly caused by mixed infection of Gram-negative bacteria. Drug sensitivity is resistant to most antimicrobial agents. The monitoring of clinical pathogens should be strengthened in clinical treatment. Antimicrobial drugs should be chosen reasonably, timely control of infection.