神经外科重症监护病房感染患者病原菌分析

目的了解神经外科重症监护病房感染患者致病菌流行病学特征,为预防和治疗神经外科感染提供依据。方法选择神经外科重症监护病房合并感染患者85例,采集痰、脑脊液、血、静脉插管及插管周围皮肤和手术切口分泌物,按常规方法进行细菌培养、鉴定。药敏试验采用微量稀释法,以 VITEK32药物敏感分析卡获得最低抑菌浓度,以标准菌大肠埃希菌ATCC25922、金黄色葡萄球菌 ATCC29213和铜绿假单胞菌ATCC27853菌株进行质量控制。结果判断参照美国国立临床实验室标准委员会标准。结果 85例患者共收集致病菌256株,其中革兰阳性菌80株(31．25％);革兰阴性菌176株 (68．75％),非发酵菌93株(52．84％),肠杆菌科83株(47．16％)。药敏试验结果显示,主要的革兰阴性菌铜绿假单胞菌、肺炎克雷伯杆菌、鲍曼醋酸钙不动杆菌对碳氢酶烯类抗生素敏感;革兰阳性菌金黄色葡萄球菌、凝固酶阴性葡萄球菌对万古霉素敏感率为100％。结论神经外科重症监护病房的主要致病菌以革兰阴性细菌为主,其中以铜绿假单胞菌、肺炎克雷伯杆菌、鲍曼醋酸钙不动杆菌常见;而革兰阳性致病菌则以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主。选择抗生素应首选能覆盖主要致病菌的广谱抗生素。

Analysis of pathogenic bacteria isolated from infectious patients in neurosurgical ICU

Objective To study the epidemiological characteristics of pathogenic bacteria isolated from infectious patients in neurosurgical ICU and provide the basis for prevention and treatment of neurosurgi-cal infections. Methods Samples of sputum, cerebrospinal fluid, blood, secretions from skin around intravenous catheters and incisions of 85 infectious patients in neurosurgical ICU were collected for routine bacterial cultivation and identification. Microdilution method was applied to get the susceptibility test and minimal inhibition concentration (MIC) were determined by VITEK32 card. Quality control had been done using standard organisms e.g. Escherichia coli ATCC25922, Staphylococcus aureus ATCC29213, and Pseudomonas aeruginosa ATCC27853. The results were evaluated according to the National Committee for Clinical Laboratory Standards (USA). Results A total of 256 pathogenic strains were isolated from 85 patients, among them 80 (31.25%) Gram-positive, 176 (68.75) Gram-negative, non-fermentative bacteria 52.84% (93/176) and En-terobacteriaceae 47.16% (83/176). Sensitization test revealed that Carbapenems were the most active antibiotics against Gram-negative organisms, such as Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acineto-bacter baumanni. The sensitive rate of Vancomycin against Staphylococcus aureus and coagulase negative Staphylococcus was 100%. Conclusion The predominant pathogens in neurosurgical ICU are Gram-negative e.g. Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumanni, while the Gram positive Staphylococcus aureus and coagulase negative are the common pathogens. Broad-spectrum antibiotics covered the predominant pathogens are the first choice in treatment of the infectious patients in neurosurgical ICU.