摘要
目的探讨和分析重型颅脑外伤患者术后下呼吸道感染相关因素及病原菌分布和耐药情况。方法选取2013年1月-2015年12月医院所收治的696例重型颅脑外伤手术患者作为研究对象,并分别对重型颅脑外伤手术患者的性别、年龄、GCS评分、基础疾病、创伤性操作、预防应用抗菌药物、营养供给、住院时间等相关因素以及病原菌分布和耐药情况进行分析。结果本研究696例重型颅脑外伤手术患者中发生下呼吸道感染75例,感染率为10.78%;年龄>60岁,GCS评分≤5分,有基础疾病,侵入性操作,预防应用抗菌药物,营养供给不足,住院时间>14d是重型颅脑外伤患者术后下呼吸道感染的危险因素,差异均具有统计学意义(P<0.05);经Logistic回归分析,GCS评分、侵入性操作以及预防应用抗菌药物是重型颅脑外伤患者术后下呼吸道感染的独立危险因素(P<0.05);75例感染患者共检出病原菌92株,其中革兰阴性菌占71.74%,革兰阳性菌占18.48%,真菌占9.78%;革兰阴性菌对美洛西林、头孢曲松、环丙沙星均表现出较高的耐药性,其耐药率均>50%,对亚胺培南的耐药性较低,革兰阳性菌对青霉素、阿奇霉素、头孢唑林、苯唑西林均表现出较高的耐药性,其耐药率均>50%,对万古霉素耐药性较低。结论重型颅脑外伤患者术后下呼吸道感染与GCS评分,侵入性操作,预防应用抗菌药物等因素相关,病原菌分布以革兰阴性菌为主,应结合其耐药情况及时合理应用抗菌药物。
OBJECTIVE To explore the related factors for postoperative lower respiratory tract infections in patients with severe traumatic brain injury and observe the distribution and drug resistance of pathogens.METHODS A total of 696 patients with severe traumatic brain injury who received surgery in the hospital from Jan 2013 to Dec2015 were recruited as the study objects.The related factors,including the gender,age,GCS score,underlying diseases,traumatic operation,prophylactic use of antibiotics,nutrition supply and length of hospital stay and distribution and drug resistance of pathogens were observed.RESULTS Of the 696 patients with severe traumatic brain injury,75 had lower respiratory tract infections,with the infection rate 10.78%.The risk factors for the postoperative lower respiratory tract infections included the more than 60 years of age,GCS score no less than 5 points,underlying diseases,invasive procedures,prophylactic use of antibiotics,insufficient nutrition supply and length of hospital stay more than 14 days,and there was significant difference（P〈0.05）.The logisticregression analysis indicated that the GCS score,invasive procedures and prophylactic use of antibiotics were the independent risk factors for the postoperative lower respiratory tract infection in the patients with severe traumatic brain injury（P〈0.05）.Totally 92 strains of pathogens were isolated from 75 patients with infection,of which 71.74% were gram-negative bacteria,18.48% were gram-positive bacteria,and 9.78% were fungi.The drug resistance rates of the gram-negative bacteria to mezlocillin,ceftriaxone and ciprofloxacin were more than 50%,and the drug resistance rates to imipenem were low;the drug resistance rates of the gram-positive bacteria to penicillin,azithromycin and oxacillin were more than 50%,and the drug resistance rates to vancomycin were low.CONCLUSION The postoperative lower respiratory tract infection in the patients with severe traumatic brain injury is associated with the GCS score,invasive procedures and pro
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第21期4912-4915,共4页
Chinese Journal of Nosocomiology
基金
浙江省自然科学基金资助项目(Y14H150026)
关键词
颅脑外伤
下呼吸道感染
病原菌分布
Brain injury
Lower respiratory tract
Distribution of pathogen
