【摘要】：目的分析開顱手術(shù)后危重患者感染的病原菌分布及其耐藥性,為臨床控制術(shù)后感染提供參考依據(jù)。方法選取2012年6月-2016年6月醫(yī)院行開顱手術(shù)患者584例,對(duì)發(fā)生術(shù)后顱內(nèi)感染的52例患者進(jìn)行細(xì)菌培養(yǎng)和藥敏試驗(yàn),分析感染患者的感染率、病原菌分布及其耐藥性;采用法國(guó)生物梅里埃公司VITEK-2Compact全自動(dòng)鑒定儀對(duì)菌株進(jìn)行鑒定,采用紙片法進(jìn)行藥敏檢測(cè),采用SPSS19.0軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。結(jié)果 584例開顱手術(shù)患者中52例患者發(fā)生術(shù)后顱內(nèi)感染,感染率為8.9%;共分離出52株病原菌,其中革蘭陰性菌36株,占69.2%,以肺炎克雷伯菌和鮑氏不動(dòng)桿菌為主,分別占30.8%和26.9%,革蘭陽性菌14株,占26.9%,以金黃色葡萄球菌和表皮葡萄球菌為主,均占11.5%,真菌2株,占3.9%;革蘭陰性菌中鮑氏不動(dòng)桿菌對(duì)頭孢曲松耐藥率最高,為78.6%,對(duì)環(huán)丙沙星耐藥率最低,為21.4%,肺炎克雷伯菌對(duì)氨曲南及環(huán)丙沙星耐藥率最高,為81.3%,對(duì)亞胺培南耐藥率最低,為12.5%;革蘭陽性菌中表皮葡萄球菌對(duì)青霉素耐藥率最高,為100.0%,對(duì)萬古霉素及利奈唑胺耐藥率最低,為0,金黃色葡萄球菌對(duì)紅霉素耐藥率最高,為83.3%,對(duì)萬古霉素及利奈唑胺耐藥率最低,為0。結(jié)論開顱手術(shù)后有較高的感染風(fēng)險(xiǎn),術(shù)后感染病原菌以革蘭陰性菌為主,且革蘭陰性菌對(duì)多種藥物都具有耐藥性,在術(shù)后治療階段需加強(qiáng)對(duì)病原菌的監(jiān)控,從而進(jìn)行有效干預(yù),控制病原菌感染,保障患者預(yù)后。
[Abstract]:Objective to analyze the distribution and drug resistance of pathogenic bacteria in critically ill patients after craniotomy, and to provide reference for clinical control of postoperative infection. Methods 584 patients undergoing craniotomy from June 2012 to June 2016 were selected to carry out bacterial culture and drug sensitivity test in 52 patients with postoperative intracranial infection, and the infection rate, pathogen distribution and drug resistance of the infected patients were analyzed, the strains were identified by VITEK-2Compact automatic identification instrument of French biological Merry company, the drug sensitivity was detected by paper method, and the data were statistically analyzed by SPSS19.0 software. Results Intracranial infection occurred in 52 of 584 patients undergoing craniotomy, the infection rate was 8.9%. A total of 52 strains of pathogenic bacteria were isolated, including 36 strains of Gram-negative bacteria (69.2%), mainly Klebsiella pneumoniae and Acinetobacter baumannii (30.8% and 26.9%), 14 strains of Gram-positive bacteria (26.9%), mainly Staphylococcus aureus and Staphylococcus epidermidis (11.5%) and 2 strains of fungi (3.9%). Among Gram-negative bacteria, Acinetobacter baumannii had the highest resistance to ceftriaxone (78.6%), ciprofloxacin (21.4%), Klebsiella pneumoniae (81.3%) and imipenem (12.5%). Among Gram-positive bacteria, Staphylococcus epidermidis had the highest resistance to penicillin (100.0%), vancomycin and linazolamide (0), Staphylococcus aureus (83. 3%) and vancomycin (0). Conclusion there is a high risk of infection after craniotomy. Gram-negative bacteria are the main pathogenic bacteria after craniotomy, and Gram-negative bacteria are resistant to a variety of drugs. It is necessary to strengthen the monitoring of pathogenic bacteria in the stage of postoperative treatment, so as to carry out effective intervention, control pathogen infection and ensure the prognosis of patients.
【作者單位】： 四川省科學(xué)城醫(yī)院四川中醫(yī)藥高等�？茖W(xué)校附屬醫(yī)院神經(jīng)外科;四川中醫(yī)藥高等�？茖W(xué)校;
【分類號(hào)】：R651.1

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