神经外科ICU患者泌尿系感染病原菌分布及耐药性分析

目的了解神经外科ICU患者泌尿系感染细菌的病原菌的分布及耐药状况，为临床合理应用抗菌药物提供依据。方法回顾性分析2007年1月至2009年1月颅脑损伤患者尿培养分离的细菌及药敏试验结果。细菌鉴定采用法国生物梅里埃公司API进行鉴定，药敏试验采用纸片扩散法（K-B法），根据美国临床实验室标准化委员会2004年判断标准分析结果。结果共分离病原菌512株，其中革兰阴性菌（G-）占58．20％（298株），革兰阳性菌（G＋）占24．41％（125株），真菌占17．38％（89株）；G-菌前3位依次是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌，占G-菌总数的94．97％；克雷伯菌属与大肠埃希菌的超广谱β-内酰胺酶（ESBLs）的检出率分别59．48％和71．67％；G＋菌前3位依次是肠菌属、葡萄球菌属、链球菌属。主要G-菌对常用抗菌药物已普遍耐药，仅对亚胺培南，环丙沙星，阿米卡星耐药率较低。主要G＋菌对万古霉素100％敏感，其中链球菌对青霉素、头孢噻肟、氯霉素也有较高的敏感性。真菌对两性霉素B、伏立康唑100％敏感。结论颅脑损伤并发泌尿系感染的主要致病菌仍为大肠埃希菌。亚胺培南对G-致病菌具良好敏感性，万古霉素对G＋致病菌具高度敏感性。真菌有增加的趋势，两性霉素B、伏立康唑是较好的抗真菌药物。

Distribution and antibiotic resistance of pathogens in Urinary System Infection of neurosurgical ICU

Objective To investigate the distribution of pathogens and drug-resisitance features in head injuriy patients with urinary tract infections in neurosurgical ICU. Methods Pathogens isolated from head injuriy patients with urinary tract infections and the drug susceptibility test from January 2007 to January 2009 was analyzed retrospectively. Results A total of 512 pathogens were collected from head injury patient s with urinary tract infections. Among all the isolated strains , 298 strains （58. 20 % ） were Gram negative bacilli , while 125 strains （24. 41% ） were Gram positive bacilli. The first 3 gramnegative bacilli were Escherichia. coil, KlebsieUa pneumonia and Pseudomonas aeruginosa , accounted for 94. 97%. The ESBLs-producing E. coil and K. pneumonia was 59.48% and 71.67% respectively. The first 3 gram-positive bacilli were Enteroeoceu, Staphylococcus,Streptococcus. The susceptible rate of gram-negaive bacilli to Imipenem,ciprofloxacin and amikacin was high. The susceptible rate of gram-positive bacilli to vancomyein was 100%. The drug susceptibility of fungi to Ampbotericin B and Voriconazole were both 100%. Conclusion The major bacterial infection of the urinary tract in head injuried patients is E. coll. Imipenem is better agents for all Gram negative bacilli isolated strains from urinary tract , while vancomycin is themost active agent for Gram positive cocci. The infection rate of fungi is increasing gradually. The fungi is sensitive to Ampbotericin B and Vorieonazole.