急诊重症脑损伤患者创伤后肠道病原菌及其耐药性

Distribution and drug resistance of intestinal pathogenic bacteria after trauma in emergency patients with severe brain injury

目的探讨重症脑损伤患者创伤后48h肠道病原菌分布与耐药情况,为临床抗菌药物应用提供临床资料。方法分析2020年1月-2022年12月杭州医学院附属临安人民医院急诊科收治的确诊中度至重度创伤性脑损伤患者,对纳入标准符合入住重症监护室的患者(n=100)在第0、24和48h采集额外粪便样本;采用添加0.2%纤维二糖和0.2%麦芽糖的VL-G滚管琼脂测定总厌氧菌数。评估培养板的微生物生长情况,病原菌使用BACTECFXTOP全自动细菌/药敏鉴定仪进行细菌鉴定,使用兼容抗微生物药敏试验纸片进行药敏试验。结果本研究共纳入100例患者,在0、24和48h从患者中采集直肠微生物样本,在3个时间点分离所有细菌均属于变形菌门,其中肠杆菌科构成最大的类群,其中分离株数最多的是大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌及奇异变形杆菌;在0~48h内,机会性致病菌奇异变形杆菌构成比变化较显著,即快速增加,并且其对头孢唑林、左氧氟沙星及青霉素3种抗菌药物耐药率较高。结论创伤性脑损伤后48h,重症脑损伤患者就与变形菌的广泛定植有关,头孢唑林、左氧氟沙星及青霉素耐药奇异变形杆菌的定植,强调正确、合理使用抗菌药物的重要性。

OBJECTIVE To investigate the distribution and drug resistance of intestinal pathogens in patients with severe brain injury 48 hours after trauma,and to provide clinical data for clinical application of antibacterial drugs.METHODS The patients with moderate to severe traumatic brain injury admitted to the emergency department of Lin'an People's Hospital affiliated to Hangzhou Medical College from Jan 2020 to Dec 2022 were enrolled.Stool samples from the patients(n=100)who met the inclusion criteria for admission to the intensive care unit were collected at the 0,24 th and 48 th hours.The total number of anaerobic bacteria which was cultured in VL-G roll tube agar added 0.2%cellobiose and 0.2%maltose was detected by Hungate roll-tube technique.And the bacteria cultured in the plate were identified by BACTECFXTOP automatic bacteria/drug sensitivity tester.drug sensitivity test was carried out by using compatible antimicrobial drug sensitivity test paper.RESULTS A total of 100 patients were included in the study.The rectal microbial samples were collected from the patients at 0,24 and 48 h.All the bacteria isolated at three time points belonged to Proteaceae,of which Enterobacteriaceae constituted the largest group,and Escherichia coli,Pseudomonas aeruginosa,Klebsiella pneumoniae and Proteus mirabilis were the most common strains,respectively.Within 0-48 h,the composition ratio of the opportunistic pathogen P.mirabilis changed significantly,which increased rapidly and had higher drug-resistant rate to cefazolin,levo-floxacin and penicillin.CONCLUSION Forty-eight hours after traumatic brain injury,patients with severe brain in-jury are associated with extensive colonization of P.mirabilis.The colonization of cefazolin,levofloxacin,and pen-icillin-resistant P.mirabilis indicates the importance of correct and rational use of antibiotics.