重症监护室脑外伤及脑血管病患者医院感染临床分析

目的了解重症监护室（ICU）脑外伤及脑血管病患者医院感染情况及病原学特点，探讨相应防治措施。方法回顾性分析某院ICU 2008-2010年收治入院的236例脑外伤及脑血管病患者病历资料。结果236例患者发生医院感染29例（12.29%），50例次（21.19%）；其中呼吸系统感染23例次（46.00%），泌尿系统感染15例次（30.00%），口腔感染4例次（8.00%），胃肠道感染3例次（6.00%），皮肤和软组织感染2例次（4.00%），其他部位感染3例次（6.00%）。共检出病原体69株，其中革兰阴性菌45株（65.22%），以铜绿假单胞菌（17株）、肺炎克雷伯菌（12株）、大肠埃希菌（10株）和鲍曼不动杆菌（4株）为主；革兰阳性菌21株（30.43%），以金黄色葡萄球菌（11株）、表皮葡萄球菌（7株）、链球菌属（2株）为主；真菌3株（4.35%）。结论该院ICU脑外伤及脑血管病患者医院感染率较高，以呼吸系统感染为主；病原体以革兰阴性菌为主。应针对性地采取有效防控措施。

Healthcare associated infection in patients with traumatic brain injury and cerebrovascular diseases in an intensive care unit

ObjectiveTo analyze the status of healthcare associated infection(HAI) and characteristics of pathogens in patients with traumatic brain injury and cerebrovascular diseases, and evaluate prevention and control measures.MethodsClinical data of 236 patients with traumatic brain injury and cerebrovascular diseases in a hospital from 2008 to 2010 were analyzed retrospectively.ResultsA total of 29 patients developed 50 times of HAI, HAI rate was 12.29%, HAI case rate was 21.19%, HAI case rate of respiratory system, urinary system, oral cavity, gastrointestinal tract,skin and soft tissue, and other sites was 46.00%（n=23），30.00%（n=15），8.00%（n=4），6.00%（n=3），4.00%（n=2），and 6.00%（n=3）respectively. A total of 69 pathogenic strains were detected，percentage of gram negative bacteria was 65.22%（n=45），the major were Pseudomonas aeruginosa（n=17）, Klebsiella pneumoniae（n=12）, Escherichia coli（n=10）, and Acinetobacter baumannii（n=4）；percentage of gram positive bacteria was 30.43%（n=21），the major were Staphylococcus aureus（n=11）, Staphylococcus epidermidis （n=7）,Streptococcus spp.（n=2）；percentage of fungi was 4.35%（n=3）.ConclusionHAI in patients with traumatic brain injury and cerebrovascular diseases is high, the main infection site is respiratory system, the main pathogens are gram negative bacteria. Preventive and control measures should be taken accordingly.