892例重症颅脑损伤患者术后继发肺部感染的病原菌分布及危险因素分析

Analysis of Pathogenic Bacteria Distribution and Risk Factors of Secondary Pulmonary Infection in 892 Patients with Severe Craniocerebral Injury After Operation

关键词:  颅脑损伤后肺部感染  病原菌分布  耐药性监测  危险因素分析

Key words:  pulmonary infection after craniocerebral injury  distribution of pathogenic bacteria  monitoring of drug resistance  analysis of risk factors

摘要:

目的 探讨医院住院重症颅脑损伤患者术后继发肺部感染的病原菌分布及危险因素。方法 收集哈励逊国际和平医院收治的892例重症颅脑损伤术后发生肺部感染的患者临床资料作为感染组，回顾性分析送检的痰标本病原菌的分布及耐药性；并同时选取120例颅脑损伤并经开颅手术后未出现肺部感染并发症的患者资料作为未感染组，比较2组的生理指标与相关临床指标，分析其发生肺部感染的危险因素。结果 病原菌中革兰阴性杆菌为主796株（89.2%），以肺炎克雷伯菌、铜绿假单胞菌和鲍曼不动杆菌为主；革兰阳性球菌84株（9.4%），以金黄色葡萄球菌和肺炎链球菌为主；真菌12株（1.4%）。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南耐药率分别为37.1%和60.2%。革兰阳性球菌未发现耐万古霉素、替加环素和利奈唑胺的菌株。单因素分析显示，肺部基础疾病、3种以上抗菌药物的使用、昏迷时间>24 h、机械性通气和吸烟史为颅脑损伤后继发肺部感染的危险因素。多因素分析显示，昏迷时间>24 h （OR=2.436，95%CI：1.165~5.321，P=0.04）和机械通气（OR=2.720，95%CI：1.343~6.986，P=0.02）为肺部感染的独立危险因素。结论 医院住院重症颅脑损伤患者术后肺部感染病原菌以革兰阴性菌为主，病原菌耐药情况不容乐观，颅脑损伤继发肺部感染的危险因素较多。

Abstract:

OBJECTIVE To investigate the distribution and risk factors of secondary pulmonary infection in hospitalized patients with severe craniocerebral injury. METHODS The clinical data of 892 patients with pulmonary infection after severe craniocerebral injury treated in Harrison International Peace Hospital were collected as infection group. The distribution and drug resistance of pathogenic bacteria in sputum samples were analyzed retrospectively. At the same time, 120 patients with craniocerebral injury and no complications of pulmonary infection after craniotomy were selected as the uninfected group. The physiological indexes and related clinical indexes of the two groups were compared, and the risk of pulmonary infection was analyzed. RESULTS The pathogenic bacteria were 796 strains of gram-negative bacillus(89.2%), Klebsiella pneumoniae, Pseudomonas aeruginosa, and Bacillus baumann were the main pathogens; 84 gram-positive cocci(9.4%), Staphylococcus aureus and Streptococcus pneumoniae were the main pathogens; 12 fungi(1.4%). The rates of resistance to imipenem by Pseudomonas aeruginosa and Bacillus baumann were 37.1% and 60.2% respectively. Gram-positive cocci did not find strains resistant to vancomycin, tegacycycline and linazolamine. Univariate analysis showed pulmonary basic disease, use of more than three antibiotics, coma time >24 h, mechanical ventilation and smoking history were the risk factors of secondary pulmonary infection after craniocerebral injury. Multivariate analysis showed that coma time >24 h(OR=2.436, 95%CI:1.165-5.321, P=0.04) and mechanical ventilation(OR=2.720, 95%CI:1.343-6.986, P=0.02) were independent risk factors for pulmonary infection. CONCLUSION Gram-negative bacteria are the main pathogenic bacteria in postoperative pulmonary infection in hospitalized patients with severe craniocerebral injury. Drug resistance of pathogenic bacteria is not optimistic. There are many risk factors for secondary pulmonary infection in patients with craniocerebral injury.