重型颅脑损伤患者术后继发肺部感染鲍曼不动杆菌危险因素分析

Analyses of Risk Factors of Severe Craniocerebral Trauma Patients with Pulmonary Infection of Acinetobacter Baumannii

关键词:  重型颅脑损伤  肺部感染  鲍曼不动杆菌  危险因素  耐药性监测

Key words:  severe craniocerebral trauma  pulmonary infection  Acinetobacter baumannii  risk factors  resistance surveillance

摘要:

目的 探讨重型颅脑损伤患者术后继发肺部感染鲍曼不动杆菌的危险因素和耐药状况，为临床预防和治疗提供依据。方法 以2014年2月-2016年3月神经外科收治的55例重型颅脑损伤继发肺部感染鲍曼不动杆菌者为观察组，同时选取55例同期收治的非鲍曼不动杆菌感染者为对照组，设计相关危险因素，分别采用单因素和多因素Logistic分析进行危险因素分析。应用纸片扩散法对鲍曼不动杆菌对常见抗菌药物进行药敏研究。数据采用SPSS 20.0软件进行统计学分析。结果 单因素及多因素研究结果显示，患者低蛋白血症、入院GCS评分、入住ICU时间、是否使用碳青霉烯类和糖皮质激素是重型颅脑损伤患者术后继发肺部感染鲍曼不动杆菌的危险因素（P<0.01）。药敏结果显示，头孢哌酮钠舒巴坦钠、阿米卡星和亚胺培南的敏感率较高，敏感率依次为78.18%，54.55%和45.45%，左氧氟沙星、氨苄西林钠舒巴坦钠和哌拉西林钠他唑巴坦钠的敏感率均<30%。结论 低蛋白血症、入院时GCS评分（<8分）、ICU住院时间（>7 d）、使用碳青霉烯类和糖皮质激素是重型颅脑损伤患者术后继发肺部感染鲍曼不动杆菌的危险因素。鲍曼不动杆菌多重耐药严重，头孢哌酮钠舒巴坦钠仍是敏感性最高的药物，其次是阿米卡星和亚胺培南，宜根据药敏试验结果选用。

Abstract:

OBJECTIVE To investigate the risk factors and analyses of antibiotic resistance of severe craniocerebral trauma patients with pulmonary infection of Acinetobacter baumannii, to provide references for clinical prevention and treatment. METHODS The clinical data of 55 patients of severe craniocerebral trauma with pulmonary infection of Acinetobacter baumannii as test group, and the same time selected 55 patients of severe craniocerebral trauma with pulmonary infection of no Acinetobacter baumannii as control group from Feb. 2014 to Mar. 2016, were analyzed to investigate related risk factors by univariate χ² analysis and multivariate Logistic analysis. Drug susceptibility of Acinetobacter baumannii to common antimicrobial agents using disk diffusion method. The data were analyzed by SPSS 20.0 software. RESULTS The study showed that low protein hyperlipidemia, GCS score, ICU stays, using penicillium carbon alkene and glucocorticoids were the risk factors for pulmonary infection of Acinetobacter baumannii(P<0.01). The antimicrobial susceptibility testing showed that sensitivity rate of cefoperazone sodium/sulbactam sodium, amikacin and imipenem for acinetobacter baumannii were much higher than others antibacterial drugs, the sensitivity rates respectively were 78.18%, 54.55% and 45.45%, and sensitivity rate of levofloxacin, ampicillin sulbactam and piperacillin sodium tazobactam were <30%. CONCLUSION Low protein hyperlipidemia, GCS score (<8 points), ICU stays (>7 d), using penicillium carbon alkene and glucocorticoids are the risk factors for pulmonary infection of Acinetobacter baumannii. Cefoperazone sulbactam are still the most active agent against Acinetobacter baumannii, followed by amikacin and imipenem. Therapy should be decided according to the results of susceptibility test.