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目的了解神经外科ICU患者泌尿系感染细菌的病原菌的分布及耐药状况,为临床合理应用抗菌药物提供依据。方法回顾性分析2007年1月至2009年1月颅脑损伤患者尿培养分离的细菌及药敏试验结果。细菌鉴定采用法国生物梅里埃公司API进行鉴定,药敏试验采用纸片扩散法(K-B法),根据美国临床实验室标准化委员会2004年判断标准分析结果。结果共分离病原菌512株,其中革兰阴性菌(G-)占58.20%(298株),革兰阳性菌(G+)占24.41%(125株),真菌占17.38%(89株);G-菌前3位依次是大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌,占G-菌总数的94.97%;克雷伯菌属与大肠埃希菌的超广谱β-内酰胺酶(ESBLs)的检出率分别59.48%和71.67%;G+菌前3位依次是肠菌属、葡萄球菌属、链球菌属。主要G-菌对常用抗菌药物已普遍耐药,仅对亚胺培南,环丙沙星,阿米卡星耐药率较低。主要G+菌对万古霉素100%敏感,其中链球菌对青霉素、头孢噻肟、氯霉素也有较高的敏感性。真菌对两性霉素B、伏立康唑100%敏感。结论颅脑损伤并发泌尿系感染的主要致病菌仍为大肠埃希菌。亚胺培南对G-致病菌具良好敏感性,万古霉素对G+致病菌具高度敏感性。真菌有增加的趋势,两性霉素B、伏立康唑是较好的抗真菌药物。
Objective To understand the distribution and drug resistance of pathogenic bacteria in urinary tract-infected bacteria in neurosurgical ICU patients and provide basis for rational use of antibacterials in clinical practice. Methods A retrospective analysis of bacterial isolation and drug susceptibility test results of urinary culture from January 2007 to January 2009 in patients with craniocerebral injury was performed. Bacterial identification was carried out by the French bioMérieux API. The susceptibility test was based on the K-B method, according to the results of the American Clinical Laboratory Standardization Committee 2004 judgment criteria. Results A total of 512 pathogenic bacteria were isolated, of which, G- accounted for 58.20% (298 strains), Gram-positive bacteria accounted for 24.41% (125 strains) and fungi accounted for 17.38% (89 strains) The top 3 strains of bacteria were Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa, accounting for 94.97% of the total number of G-bacteria. The strains of Klebsiella and Escherichia coli were extended-spectrum β-lactams The detection rates of ESBLs were 59.48% and 71.67%, respectively. The top three G + bacteria were Enterobacter, Staphylococcus and Streptococcus. The main G-bacteria commonly used antimicrobial drugs have been generally resistant, only imipenem, ciprofloxacin, amikacin lower resistance rate. The main G + bacteria is 100% sensitive to vancomycin, of which Streptococcus also has high sensitivity to penicillin, cefotaxime and chloramphenicol. Fungi on amphotericin B, voriconazole 100% sensitive. Conclusion The main pathogens of traumatic brain injury and urinary tract infection are still Escherichia coli. Imipenem is highly sensitive to G-pathogenic bacteria and vancomycin is highly sensitive to G + pathogenic bacteria. Fungi have an increasing trend, amphotericin B and voriconazole are better antifungal agents.