颅脑外伤致昏迷患者发生下呼吸道感染的病原学特征及防控

目的:探讨颅脑外伤所致昏迷患者下呼吸道感染的病原菌分布及耐药性,分析其相关危险因素,为临床预防该类感染提供参考。方法:选择2013年1月~2014年12月我院诊治的160例颅脑外伤致昏迷患者,对发生下呼吸道感染的80例患者采样并进行病原菌检测和药敏试验,采用Logistic回归分析探索颅脑外伤致昏迷患者发生下呼吸道感染的危险因素。结果:160例颅脑外伤致昏迷患者中,发生下呼吸道感染80例,占50.00%,共分离出病原菌85株,革兰阴性菌59株,占69.41%,革兰阳性菌20株,占23.53%,真菌6株,占7.06%。革兰阴性菌对氨苄西林和头孢曲松的耐药率较高,对左氧氟沙星和庆大霉素的耐药性较低;革兰阳性菌对氨苄西林和四环素的耐药率较高,而对万古霉素和替考拉宁的耐药率较低;多因素Logistic回归分析显示,侵入性操作、使用抗生素是颅脑外伤致昏迷患者发生下呼吸道感染的危险因素(P0.05)。结论:颅脑外伤致昏迷患者发生下呼吸道感染的主要病原菌为革兰阴性菌,临床可通过减少侵入性操作及合理使用抗生素预防该类感染。

Pathogenic Characteristics and Prevention Strategy of Respiratory Tract Infection in Patients with Coma Caused by Craniocerebral Trauma

ABSTRACT Objective: To investigate the distribution of pathogenic bacteria and drug resistance of respiratory tract infection in patients with coma caused by craniocerebral trauma, and provide the reference for clinical prevention of this type of infection through analyzing its risk factors. Methods: 160 patients with coma caused by craniocerebral trauma in our hospital from January 2013 to December 2014 were chosen. Pathogenic bacteria and drug resistance test were performed in samples of 80 patients with lower respiratory tract infection, and Logistic regression analysis were conducted to find out the risk factors of lower respiratory tract infection in patients with coma caused by craniocerebral trauma. Results: A total of 80 patients occurred lower respiratory tract infection in 160 patients with coma caused by craniocerebral trauma, accounting for 50.00%, 85 strains of pathogenic bacteria were identified, including 59 strains of gram negative bacteria which accounted for 69.41%, 20 strains of gram positive bacteria which accounted for 23.53% and 6 strains of fungi which accounted for 7.06%. Gram negative bacteria had higher resistance to ampicillin and ceftriaxone, but lower resistance to levofloxacin and gentamicin. Gram positive bacteria had higher resistance to ampicillin and tetracycline, but lower resistance to vancomycin and teicoplanin. Multivariate Logistic regression analysis showed that invasive operation, using antibiotics were risk factors for respiratory tract infection in patients with coma caused by craniocerebral trauma. Conclusion: The main pathogenic bacteria of respiratory tract infection in patients with coma caused by craniocerebral trauma is gram negative bacteria, the clinic could prevent the such kind of infection by reducing the invasive operation and reasonable use of antibiotics.