神经重症康复单元意识障碍患者医院感染的调查与分析

目的探讨神经重症康复单元意识障碍患者发生医院感染的临床特征,为指导抗生素合理应用、控制医院感染提供依据。方法回顾性分析在神经重症康复单元治疗的72例脑部疾病致意识障碍患者的临床资料。对患者的年龄、性别、疾病种类、感染部位、标本类型、病原菌种类等指标进行统计分析。结果本组患者中,创伤性颅脑损伤者31例(43.1%),非创伤性脑部疾病者41例(56.9%)。送检标本中,痰标本88例次(50.9%);感染部位以呼吸系统最多,共87例次(54.7%)。在检出的病原菌中,前三位依次是铜绿假单胞菌(26株,16.4%)、肺炎克雷伯菌(23株,14.5%)、鲍曼不动杆菌(20株,12.6%);在耐药菌中,鲍曼不动杆菌多重耐药十分严重,共16例,占80%。结论神经重症康复单元意识障碍患者的肺部感染发生率高,以革兰氏阴性杆菌感染占比大。加强综合管理措施,合理应用抗生素才能有效控制医院感染。

Investigation and analysis of nosocomial infections of patients with disorders of consciousness in HDU for rehabilitation

Objective To investigate the clinical characters of nosocomial infections in high dependency unit(HDU)for neurological rehabilitation,and guide the use of antibiotics and the management of nosocomial infections.Methods The clinical data of patients with disorders of consciousness(DOC)caused by severe brain injury from November 2016 to November 2017 in the HDU were analyzed retrospectively.The patients-age,gender,etiology,sites of infection and pathogenic species were analyzed statistically.Results Of 72 patients with nosocomial infections,31 were caused by traumatic brain injury(43.1%)and 41 were caused by non-traumatic brain injury(56.9%),such as cerebral infarction,cerebral hemorrhage,cerebellar and brainstem hemorrhage,poisoning,hypoxic ischemic encephalopathy after cardio-pulmonary resuscitation.The most frequent specimen came from sputum(50.9%).The respiratory system had the highest rate of infection(54.7%).Among the cultivated bacteria,the first three pathogens were Pseudomonas aeruginosa(16.4%),Klebsiella pneumoniae(14.5%),Acinetobacter baumannii(12.6%).Drug sensitivity results showed that most of the tested Acinetobacter baumannii were multidrug-resistant(80%).Conclusions HDU for neurological rehabilitation has its own characters and the incidence of nosocomial infection is high.Gram negative bacilli account for a large proportion.Comprehensive measures including enhancing ward management,reasonable application of antibiotics should be applied to control the situation.