ICU脑外伤及脑血管病患者肺部感染的病原学特点及影响因素分析

Etiological characteristics and influencing factors for pulmonary infection in ICU patients with brain trauma and cerebrovascular diseases

目的 探讨重症监护病房(ICU)脑外伤及脑血管病患者肺部感染的病原菌分布及其耐药性,分析引起患者肺部感染的影响因素。方法 选取2015年1月-2016年12月医院ICU收治的100例脑外伤及脑血管病并发肺部感染患者作为感染组,采集患者痰液标本进行病原菌的鉴定及药敏试验。另选取同期未发生肺部感染脑外伤及脑血管病患者100例作为未感染组,单因素及多因素logistic回归分析发生肺部感染的影响因素。结果 100例感染患者共检出病原菌147株,革兰阳性菌73株占49.7%、革兰阴性菌61株占41.5%,真菌13株占8.8%;革兰阴性菌主要以铜绿假单胞菌和鲍氏不动杆菌为主,对氨芐西林、磺胺甲噁唑/甲氧苄啶、头孢替坦和头孢唑林的耐药性较高,对妥布霉素和亚胺培南的耐药性较低;革兰阳性菌主要以金黄色葡萄球菌和表皮葡萄球菌为主,对红霉素、青霉素、阿莫西林和舒巴坦的耐药性较高,对呋喃妥因和万古霉素的耐药性较低;多因素logistic回归分析显示,APACHEⅢ评分和机械通气是ICU脑外伤及脑血管病并发肺部感染的独立影响因素。结论 ICU脑外伤及脑血管病患者要积极处理发生肺部感染的影响因素,合并肺部感染的患者以革兰阳性菌感染占比较高,应根据患者病原菌药敏结果进行针对性治疗。

OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from intensive care unit( ICU)patients with brain trauma and cerebrovascular diseases complicated with pulmonary infection and analyze the influencing factors for the pulmonary infection.METHODS Totally 100brain trauma and cerebrovascular diseases patients complicated with pulmonary infection who were treated in ICU from Jan 2015to Dec 2016were assigned as the infection group,the sputum specimens were collected for culture of pathogens,the isolated pathogens were identified,the drug susceptibility testing was performed,meanwhile,100brain trauma and cerebrovascular disease patients who did not have pulmonary infection were set as the non-infection group,and the univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the pulmonary infection.RESULTS A total of 147strains of pathogens were isolated from 100patients with infection,73(49.7%) of which were gram-positive bacteria,61 (41.5%)were gram-negative bacteria,and 13 (8.8%)were fungi. Pseudomonas aeruginosa and Acinetobacter were dominant among the gram-negative bacteria and were highly resistant to ampicillin,sulfamethoxazole-trimethoprim,cefotetan and cefazolin,while the drug resistance rate to tobramycin and imipenem was low.Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of the gram-positive bacteria and were highly resistant to erythromycin,penicillin,amoxicillin and sulbactam, and the drug resistance rate to nitrofurantoin and vancomycin was low.The multivariate logistic regression analysis showed that APACHEⅢscore and mechanical ventilation were the independent influencing factors for the pulmonary infection in the ICU patients with brain trauma and cerebrovascular diseases.CONCLUSIONIt is necessary to attach great importance to the influencing factors for the pulmonary infection in the ICU patients with brain trauma and cerebrovascular diseases,the gram-positive bacteria are dominant among the pathogens causing the pulmonary infection,and the targeted drug therapy should be conducted based on the result of the drug susceptibility testing.