创伤专科医院颅脑外伤患者医院感染病原菌分布与耐药性分析

摘要

Objective To guide clinical rational use of anti-bacterial drugs and provid a useful reference,we explored pathogenic bacteria species and susceptibility and resistance of anti-bacterial drugs of hospital infection in trauma hospital.Methods Retrospective investigated hospital infection of hospitalized patients with craniocerebral trauma,from June 2012 to June 2015,in our trauma hospital.Major bacterial species were statistical analysized.Results 2402 cases of hospitalized patients suffered with craniocerebral trauma were investigated.Of them,298 cases of hospital infection occurred,the infection rate was 12.4％.Most commonly infected site was lower respiratory tract (58.2％),followed by urinary tract (13.42％),upper respiratory tract (12.76％),wound (8.75％),and intracranial (13.42％).332 strains of positive pathogenic bacteria was isolated,of which pseudomonas aeruginosa accounted for 26.72％,pneumonia klebsiella bacteria,acinetobacter baumannii,e.coli,dung enterococcus,staphylococcus aureus,accounted for 24.25％,15.42％,13.47％,10.34％ and 8.64％ respectively.Klebsiella pneumoniae and e.coli resistant rate to imipenem were 9.15％,10.16％.The resistant rate of vancomycin and piperacillin/he to dung enterococcus and pneumonia klebsiella bacteria resistant rate is 3.15％,and 19.46％.Conclusion Hospital infection of patients with craniocerebral trauma in trauma hospital was obviously higher than that of other clinical departments.Pathogenic bacteria drug resistance is serious thus hospital infection mornitoring and management is of particular significance.%目的 探讨创伤专科医院颅脑外伤患者医院感染的病原菌种类、易感部位及耐药性情况,以指导临床合理用药及减少耐药菌的产生提供参考依据.方法 回顾性调查2012年6月-2015年6月北京市红十字会急诊抢救中心因颅脑外伤住院患者相关临床资料,对分离出的主要病原菌进行统计分析.结果 颅脑外伤2 402例住院患者中,发生医院感染298例,感染率为12.4％;感染部位主要为下呼吸道,占58.2％,其次为泌尿道、上呼吸道、创口、颅内,分别占13.42％、12.76％、8.75％、6.87％;从送检标本中分离出阳性病原菌332株,其中以铜绿假单胞菌居首位占26.72％,其次为肺炎克雷伯菌、鲍曼不动杆菌、大肠埃希菌、粪肠球菌、金黄色葡萄球菌,分别占24.25％、15.42％ 13.47％、10.34％、8.64％.肺炎克雷伯菌、大肠埃希菌对亚胺培南耐药率最低,分别为9.15％、10.16％,万古霉素、哌拉西林/他唑巴坦分别对粪肠球菌和肺炎克雷伯菌的耐药率也较低,分别为3.15％、19.46％.结论 创伤专科医院颅脑外伤患者的医院感染率明显高于其他临床科室,且病原菌耐药严重,应加强医院感染管理,加强耐药菌监测与控制.