Zhongguo cuzhong zazhi (Jan 2023)
高分级动脉瘤性蛛网膜下腔出血患者术后肺炎病原学及耐药性分析 Etiology and Antibacterial Drug Resistance Analysis of Post-microsurgery Pneumonia in Patients with Poor-grade Aneurysmal Subarachnoid Hemorrhage
Abstract
目的 探讨高分级动脉瘤性蛛网膜下腔出血患者术后肺炎病原学特点和其耐药性，为抗菌药物的合理使用提供参考依据。 方法 回顾性分析2013年10月—2020年12月手术治疗的Hunt-Hess Ⅳ～Ⅴ级动脉瘤性蛛网膜下腔出血患者的临床资料，分析痰培养病原菌情况及抗菌药物敏感试验结果。 结果 共纳入183例患者，均有肺部感染，其中122例（66.7%）行气管切开治疗。有451份痰培养标本，其中284份（63.0%）痰培养标本为阳性，检出病原菌305株，其中革兰阴性菌229株（75.1%）、革兰阳性菌38株（12.5%）、真菌38株（12.5%），未发现厌氧菌，混合感染有21份（7.4%）。183例肺部感染患者中痰培养病原菌改变者44例（24.0%）。革兰阴性菌主要是肺炎克雷伯杆菌（32.8%）、鲍曼不动杆菌（16.2%）、铜绿假单胞菌（14.4%）和大肠杆菌（12.7%），其中肺炎克雷伯杆菌和鲍曼不动杆菌产超广谱β-内酰胺酶菌株的比例分别为36.0%、51.4%；药敏试验结果显示其对亚胺培南、哌拉西林/他唑巴坦、妥布霉素、替加环素敏感性高。革兰阳性菌主要是金黄色葡萄球菌属（92.1%），其中耐甲氧西林金黄色葡萄球菌的比例为48.6%；药敏试验结果显示其对万古霉素、利奈唑胺和利福平敏感性高。真菌主要是白色念珠菌（39.5%），对抗真菌药物均敏感。 结论 高分级动脉瘤性蛛网膜下腔出血患者术后肺部感染率高，以革兰阴性菌为主，耐药性强，应根据其病原学特点和药敏试验结果合理选用抗菌药物。 Abstract: Objective To investigate the etiology characteristics and drug resistance of post-microsurgery pneumonia in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH), to provide reference for rational use of antibiotics. Methods The clinical data of patients with Hunt-Hess Ⅳ-Ⅴ aSAH who received microsurgery treatment were retrospectively analyzed, to analyze the sputum culture pathogens and antimicrobial susceptibility test (AST). Results A total of 183 cases were included in this study, and they all had lung infection and 122 cases (66.7%) received tracheotomy. Of 451 sputum specimens, 284 (63.0%) were positive. 305 strains of bacteria were isolated from positive specimens, including 229 strains (75.1%) of Gramnegative bacteria, 38 strains (12.5%) of Gram-positive bacteria, 38 strains (12.5%) of fungi, and no anaerobic bacterium was found. The mixed infection occurred in 21 specimens (7.4%). Sputum culture bacteria changed in 44 cases (24.0%). The Gram-negative bacteria were mainly Klebsiella pneumoniae (32.8%), Acinetobacter baumannii (16.2%), pseudomonas aeruginosa (14.4%) and escherichia coli (12.7%). The ratio of Klebsiella pneumoniae and Acinetobacter banmannii producing the extended spectrum β-lactamases (ESBLs) strains was 36.0% and 51.4%, respectively; and the AST showed that most of the strains were sensitive to imipenem, piperacillin and tazobactam, tobramycin, and tegacyclin. The Gram-positive bacteria were mainly Staphylococcus aureus (92.1%), of which the proportion of Methicillin-resistant Staphylococcus aureus (MRSA) were 48.6%; and the AST showed that the strains were sensitive to vancomycin, linezolid and Li Fuping. Fungi was mainly Candida albicans (39.5%), and they were sensitive to antifungal drugs. Conclusions The patients with poor-grade aSAH had high risk of post-microsurgery pneumonia; and the pathogens were mainly Gram-negative bacteria, and they had strong drug resistance.
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