【摘要】：目的了解重癥顱腦損傷患者呼吸道分泌物病原類型及其耐藥情況,為臨床抗感染防治提供有效指導(dǎo)。方法收集本院2016年1-12月就診的411例重癥顱腦損傷患者的臨床資料,分析患者呼吸道分泌物病原學(xué)感染情況,用K-B法對(duì)各主要病原菌的耐藥性進(jìn)行檢測(cè),用PCR擴(kuò)增法檢測(cè)金黃色葡萄球菌耐藥基因。結(jié)果從患者呼吸道分泌物中分離出128株病原菌,其中革蘭陰性菌68株,革蘭陽(yáng)性菌46株,真菌14株。革蘭陰性菌中鮑曼不動(dòng)桿菌20株,肺炎克雷伯菌14株,銅綠假單胞菌12株,大腸埃希菌10株,其他革蘭陰性菌12株。革蘭陽(yáng)性菌中金黃色葡萄球菌17株,表皮葡萄球菌12株,肺炎鏈球菌9株,其他革蘭陽(yáng)性菌14株。鮑曼不動(dòng)桿菌對(duì)哌拉西林/他唑巴坦、頭孢哌酮/舒巴坦、頭孢他啶、頭孢噻肟、亞胺培南、美羅培南、氧氟沙星的耐藥率分別為30.00%、20.00%、65.00%、50.00%、0%、10.00%、25.00%,肺炎克雷伯菌耐藥率分別為14.29%、14.29%、71.43%、71.43%、0%、0%、50.00%,銅綠假單胞菌耐藥率分別為50.00%、41.67%、58.33%、58.33%、16.67%、16.67%、41.67%。金黃色葡萄球菌對(duì)青霉素、紅霉素、環(huán)丙沙星、萬(wàn)古霉素、利福平、慶大霉素、氨芐西林的耐藥率分別為76.47%、64.71%、52.94%、0%、17.65%、47.06%、58.82%,表皮葡萄球菌耐藥率分別為75.00%、16.67%、50.00%、0%、25.00%、50.00%、16.67%,肺炎鏈球菌耐藥率分別為66.67%、22.22%、33.33%、0%、0%、44.44%、0%。17株金黃色葡萄球菌中mecA基因檢出率為76.47%(13/17),qacA基因檢出率為52.94%(9/17),ermB基因檢出率為47.06%(8/17),aac(6')/aph(2")基因檢出率為29.41%(5/17)。結(jié)論重癥顱腦損傷患者呼吸道感染病原菌主要為革蘭陰性菌,以鮑曼不動(dòng)桿菌最多;革蘭陽(yáng)性菌感染治療可優(yōu)選萬(wàn)古霉素和利福平,革蘭陰性菌可優(yōu)選亞胺培南和美羅培南;金黃色葡萄球菌耐藥程度較高,耐藥基因攜帶率也較高。
[Abstract]:Objective to investigate the pathogenic types and drug resistance of respiratory secretions in patients with severe craniocerebral injury, and to provide effective guidance for the prevention and treatment of clinical anti-infection. Methods the clinical data of 411 patients with severe craniocerebral injury in our hospital from January to December 2016 were collected, and the pathogenic infection of respiratory secretion was analyzed. The drug resistance of the main pathogens was detected by K-B method. Staphylococcus aureus resistance gene was detected by PCR amplification. Results 128 strains of pathogenic bacteria were isolated from the respiratory secretions of the patients, including 68 Gram-negative bacteria, 46 Gram-positive bacteria and 14 fungi. There were 20 Acinetobacter baumannii, 14 Klebsiella pneumoniae, 12 Pseudomonas aeruginosa, 10 Escherichia coli and 12 other Gram-negative bacteria. There were 17 strains of Staphylococcus aureus, 12 strains of Staphylococcus epidermidis, 9 strains of Streptococcus pneumoniae and 14 strains of other Gram-positive bacteria. Acinetobacter baumannii p-piperacillin / tazobactam, cefoperazone / sulbactam, ceftazidime, cefotaxime, imipenem, meropenem, The drug resistance rates of ofloxacin were 30.002 / 20.00 and 65.00 / 55.00, respectively. There were 55.00 and 25.00, respectively. The drug resistance rate of Klebsiella pneumoniae was 14.2929 14.2914.290.The drug resistance rate of Pseudomonas aeruginosa was 50.0041.6758.338.338.3316.6716. 67 and the resistance rate of Pseudomonas aeruginosa was 41.67. Staphylococcus aureus, penicillin, erythromycin, ciprofloxacin, vancomycin, rifampicin, gentamicin, 姘ㄨ媱瑗挎灄鐨勮，

本文編號(hào)：2190076