某神经外科病房医院获得性肺炎常见革兰阴性菌及耐药特征分析

Analysis of common Gram-negative bacteria and drug resistance of hospital-acquired pneumonia in inpatient of neurosurgery

目的调查神经外科医院获得性肺炎(hospital-acquired pneumonia,HAP)中常见革兰阴性菌的分布特点,分析耐药特征,为控制HAP发生提供科学依据。方法以上海某三级甲等医院神经外科住院患者为研究对象,通过医院院内感染监测系统以及检验科信息系统收集临床相关资料及病原菌分离情况。结果共分离非重复细菌1 075株,分离细菌中革兰阴性菌共有893株(83. 1%),主要包括肺炎克雷伯菌291株(27. 1%)、鲍曼不动杆菌210株(19. 5%)和铜绿假单胞菌178株(16. 6%)。肺炎克雷伯菌对阿米卡星耐药率最低,为31. 6%。产超广谱β-内酰胺酶肺炎克雷伯菌共检测出217株(74. 6%)。鲍曼不动杆菌对左旋氧氟沙星耐药率最低,为46. 7%。铜绿假单胞菌对哌拉西林/他唑巴坦耐药率最低,为11. 8%。结论目前神经外科HAP常见病原菌以革兰阴性菌为主,耐药性普遍,神经外科应监测制定和参照耐药谱,规范使用抗菌药物。

Objective To describe the characteristics of common Gram-negative bacteria in hospital-acquired pneumonia(HAP)of neurosurgery and analyze their drug resistance,so as to provide scientific basis for controlling HAP.Methods Neurosurgical inpatients in a third-level first-class hospital in Shanghai were selected as the research objects.Hospital infection surveillance system and laboratory information system were used to collect clinically relevant data and status of pathogens.Results A total of 1 075 non-repetitivebacteria were isolated,among which 893 strains(83.1%)were Gram-negative bacteria,including 291 strains of Klebsiella pneumoniae(27.1%),210 strains of Acinetobacter baumannii(19.5%),and 178 strains of Pseudomonas aeruginosa(16.6%).The resistance rate of Klebsiella pneumoniae to amikacin was the lowest(31.6%).A total of 217 strains(74.6%)of extended-spectrumβ-lactamases(ESBLs)-producing Klebsiella pneumoniae were detected.The resistance rate of Acinetobacter baumannii to levofloxacin was the lowest(46.7%).The resistance rate of Pseudomonas aeruginosa to piperacillin/tazobactam was the lowest(11.8%).Conclusion Gram-negative bacteria are the main pathogens of HAP in neurosurgery.The drug resistance of HAP was common.Neurosurgery should formulate and refer to the drug resistance spectrum regularly,to standardize the use of antibiotics.