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目的了解颅脑外伤合并泌尿道感染患者的病原菌分布及耐药性,为临床防治医院感染提供参考依据。方法对126例颅脑外伤合并泌尿道感染患者的实验室检验结果进行回顾性分析,考察泌尿道感染的诱因、病原菌种类及其药敏试验结果。结果造成泌尿道感染的主要原因是:留置导尿管、昏迷时间超过7 d、慢性基础性疾病、颅脑手术、泌尿道并发症。147株病原菌的类型主要为革兰阴性菌和真菌,构成比分别为46.26%和36.05%。菌种主要是大肠埃希菌(23.81%)、白色念珠菌(17.59%)、热带念珠菌(13.60%)、粪肠球菌(10.88%)、鲍曼不动杆菌(9.52%)、金黄色葡萄球菌(4.76%)、肺炎克雷伯菌(4.08%)。大肠埃希菌、鲍曼不动杆菌、肺炎克雷伯菌对亚胺培南、美罗培南的敏感率均为100%,对头孢吡肟、头孢噻肟、阿米卡星、头孢西丁的耐药率较低,而对哌拉西林、头孢他啶、左氧氟沙星的耐药率较高。粪肠球菌、金黄色葡萄球菌对万古霉素、利奈唑胺的敏感率均为100%,而对青霉素、苯唑西林、庆大霉素的耐药率较高。白色念珠菌、热带念珠菌对两性霉素B的敏感率均为100%,而对氟康唑、伊曲康唑、伏立康唑有不同程度的耐药。结论通过监测病原菌的分布、变化及其药敏特点,可确立合理的抗菌药物应用方案,有利于控制颅脑外伤后泌尿道医院感染。
Objective To understand the distribution and drug resistance of pathogens in patients with traumatic brain injury and urinary tract infection and provide reference for clinical prevention and treatment of nosocomial infections. Methods A retrospective analysis was performed on the laboratory test results of 126 patients with traumatic brain injury and urinary tract infection. The causes of urinary tract infection, the types of pathogens and the drug susceptibility test results were investigated. Results The main causes of urinary tract infection are: indwelling catheter, coma time more than 7 d, chronic underlying diseases, craniocerebral surgery, urinary tract complications. The main pathogens of 147 pathogens were Gram-negative bacteria and fungi, with the proportions of 46.26% and 36.05%, respectively. Escherichia coli (23.81%), Candida albicans (17.59%), Candida tropicalis (13.60%), Enterococcus faecalis (10.88%), Acinetobacter baumannii (9.52% Coccus (4.76%), Klebsiella pneumoniae (4.08%). Escherichia coli, Acinetobacter baumannii and Klebsiella pneumoniae were 100% sensitive to imipenem and meropenem. The sensitivity of cefepime, cefotaxime, amikacin and cefoxitin Resistance rate is low, and piperacillin, ceftazidime, levofloxacin resistance rate higher. Enterococcus faecalis, Staphylococcus aureus to vancomycin, linezolid sensitive rate was 100%, while the penicillin, oxacillin, gentamicin resistance rate is higher. Candida albicans, Candida tropicalis sensitivity of amphotericin B were 100%, while fluconazole, itraconazole, voriconazole have different levels of resistance. Conclusion By monitoring the distribution and changes of pathogenic bacteria and their drug susceptibility characteristics, a rational antibacterial drug regimen can be established, which is good for controlling urinary tract nosocomial infection after traumatic brain injury.