神经外科颅内出血患者下呼吸道感染病原菌的耐药性监测

目的了解神经外科重症监护室（NICU）颅内出血患者下呼吸道感染病原菌的种类及耐药情况，为临床合理用药提供依据。方法对2010年1月至2011年1月颅内出血的患者，其下呼吸道感染病原菌的种类及耐药性进行回顾性分析。结果分离出的374例病原菌中以革兰阴性杆菌为主，占81．8％，革兰阳性球菌占4．0％，真菌占14．2％。分离率较高的细菌依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌、金黄色葡萄球菌。其中，产超广谱β-内酰胺酶（ESBLs）的肺炎克雷伯菌的检出率为50．0％；耐甲氧西林金黄色葡萄球菌（MRSA）的检出率为73．3％。鲍曼不动杆菌和铜绿假单胞菌对丁胺卡那、妥布霉素、多粘菌素B有较好的敏感性；而金黄色葡萄球菌对复方新诺明、呋喃妥因、万古霉素耐药率较低。结论NICU颅内出血患者下呼吸道感染以多重耐药的革兰阴性杆菌为主，临床应根据药敏结果合理用药，控制和减少感染的发生。

Supervising drug resistance of pathogens from intracranial hemorrhage patients with lower respiratory tract infections in neurosurgical department

Objective To investigate the species and antibiotic resistance of pathogens from intracranial hemorrhage patients with lower respiratory tract infections in neurosurgical NICUs and provide scientific basis for clinical rational medication.Method The species and antibiotic resistance of pathogens from intracranial hemorrhage patients with lower respiratory tract infections from January 2010 to January 2011 was retrospectively analyzed.Result The main pathogenic bacteria from the 374 isolated pathogen strains was Gram negative bacilli(81.8%),Gram-positive cocci(4.0%),and fungi(14.2%).The pathogens with higher separation rate were Acinetobacter baumannii,Pseudomonas aeruginosa,Klebesiella pneumonia,Stenotrophomonas maltophilia,and Staphylococcus aureus.Of the Klebesiella pneumonia,50.0% produced ESBLs(+).The detection ratio of MRSA was 73.3%.Acinetobacter baumannii and Pseudomonas aeruginosa had a higher sensitivity to Amikacin,Tobramyci and Polymyxin B;Staphylococcus aureus had a lower drug resistance ratio to Trimethoprim-sulfamethoxazo,Furantoin and Vancomycin.Conclusion The major cause of bacterial infection in intracranial hemorrhage patients with lower respiratory tract infections in NICUs is the multidrug-resistant Gram negative bacilli.The clinical medication should be based on the antimicrobial susceptibility test results in order to control and reduce the incidence of infection.