重型颅脑损伤患者下呼吸道感染细菌分布及预防措施

目的 分析重症监护室（ICU）重型颅脑损伤患者下呼吸道感染病原菌分布及耐药性,为临床合理应用抗菌药物治疗提供依据.方法 对80例重型颅脑损伤患者下呼吸道标本进行病原菌分布及耐药性分析.结果 80例重型颅脑伤患者检测出96株病原菌,革兰阴性杆菌78株（81.3％）,其中鲍曼不动杆菌21株（21.9％）,铜绿假单胞菌15株（15.6％）,肺炎克雷伯菌15株（15.6％）,大肠埃希菌9株（9.4％）,嗜麦芽窄食单胞菌7株（7.3％）,阴沟肠杆菌6株（6.3％）.鲍曼不动杆菌仅对头孢哌酮/舒巴坦仍保持较高的敏感性;阴沟肠杆菌仅对亚胺培南、头孢哌酮/舒巴坦仍保持较高的敏感性.耐甲氧西林金黄色葡萄球菌（MRSA）的检出率（80％）较高,万古霉素、利奈唑胺可作为首选.结论 医院感染具有多重感染多重耐药的特点,故应合理使用抗菌药物,建立严格的保护性隔离措施.

Distributions and preventive measures of pathogenic bacteria causing lower respiratory tract infection in patients with severe brain trauma

Objective To retrospective analyse of intensive care unit （ ICU ） in severe brain trauma patients with lower respiratory tract infection pathogenic bacteria distribution and drug resistance analysis, for clinical rational use of antibacterial drugs in the treatmeut to provide the basis for. Methods A retrospective study of the distributions and re- sistance of the lower respiratory tracts specimens of 80 patients with severe brain trauma and concurrent lower respiratory tract infection was performed. Results 96 strains of pathogenic bacteria were identified from the specimens of the 80 pa- tients and 78 strains of them （81.3%） were Gram-negative bacilli. 21.9%, 15.6%, 15.6%, 9.4%, 7.3% and 6.3% of them were A. baumannii, P. aeruginosa, K. pneumoniae, E. coli, S. maltophilia and E. cloacae. A. baumannii was sensi- tive only to cefoperazone/sulhactam. E. cloacae was sensitive only to Imipenum and cefoperazone/sulbactam. Methicillin resistant Staphylococcus aureus （MRSA） had a relatively high detection rate of 80%, and Vancomycin and Linezolid should be the first choice for MRSA. Conclusion In the hospital infection, there were multi-antibiotic resistance.