脑外伤患者并发下呼吸道感染痰细菌培养和药敏分析

目的:了解严重的脑外伤患者合并下呼吸道感染细菌菌谱分布和体外药敏试验状况、耐药机制、合理指导选用抗生素。方法:严重的脑外伤患者合并下呼吸道感染的痰液作细菌培养,按常规方法分离,应用SENSITITER-sams自动细菌分析仪鉴定到种和作药物敏感试验,采用产色头孢菌素法检测β-内酰胺酶(ESBLs)和双纸片协同试验作超广谱β-内酰胺酶初筛。结果:318份痰标本中分离到237例阳性,细菌207株和酵母样真菌47株,合并感染42例。156株G-杆菌中检出产ESBLs的肺炎克雷伯菌11株和产ESBLs的大肠埃希菌5株;12株金黄色葡萄球菌中检出6株耐苯唑青霉素菌(MRSA),在42株凝固酶阴性葡萄球菌检出24株耐苯唑青霉素菌(MRCNS)。结论:脑外伤患者合并下呼吸道感染的细菌种类多、菌谱复杂,菌株呈现多重耐药性。以非发酵菌感染占多数,铜绿假单胞菌感染居首位。二重感染以合并酵母样真菌多见,革兰阳性球中耐苯唑青霉素的菌株占总数的58.5%。

Analysis of the Bacteriai Cultures and the Antibiotic Susceptibility Test of Sputum Specimens from the Brain Trauma Patients Complicated with Inferior Respiratory Tract Infection

Objective To investigate the bacterial species distribution and the state of drug-resistance from the sputa of the brain trauma patients complicated with inferior respiratory tract infection,for guiding doctors to choose suitable drugs.Methods The sputum specimens from the severe brain trauma patients with inferior respiratory tract infection were collected for bacteria culture.All the isolated strains were species-identified using SENITTTER-sams autobacterial analyzer,and their drug-sensitivity were tested.The Beta-lactamases were detected by nitrocefin test,and the extended spectrum Beta-lactamases were preliminary detected by the double paper disc test.Results From 318 cases of sputum samples,237 clinical isolates were obtained,including 207 strains of bacteria and 47 strains of fungi.In 42 cases there were mixed infections.Within the 156 strains of Gram-negative bacilli,there were 11 strains of ESBLs-producing K.pneumoniae and 5 strains of ESBLs-producing E.coli.6 strains of methecillin resistant Staphylococcus aureus(MRSA)were detected from 12 strains S.aureus,and 24 strains of methecillin resistant coagulase negative Staphylococcus(MRCNS)from 42 strains of CNS.Conclusion The species of the clinical isolates mentioned above were various.The bacterial strains showed multiple antibiotics resistance.Most of them belonged to non-fermenters and Pseudomonas aeruginosa was in the majority.The yeast-like fungi were common in the superinfection cases.The rate of MRSA strains in Gram-positive cocci was as high as 58.5%.