目的：探讨神经外科患者痰标本来源的病原菌分布和耐药性，为临床合理用药和院感监控提供科学参考。方法收集2011年1月至2013年12月入住神经外科患者的临床资料，分析痰培养的鉴定及药物敏感试验结果，采用WHONET 5.4软件进行统计。结果共送检合格痰标本753例，培养分离病原菌344株，其中最多为革兰阴性杆菌285株，占82.8%；革兰阳性球菌31株，占9.0%；真菌28株，占8.2%。神经外科患者是多重耐药菌易感的高危人群，鲍曼不动杆菌对亚胺培南的耐药性进一步恶化，耐药率>80%；肠杆菌科细菌对碳青霉烯类药物仍保持较高的敏感性，大肠埃希菌、肺炎克雷伯菌的ESBL的检出率分别为61.9%和46.5%，检出亚胺培南耐药肺炎克雷伯菌3株，MRSR检出率为58.9%，末检出万古霉素耐药的葡萄球菌。结论临床应加强神经外科患者痰培养的监测，提高标本送检率，关注病原菌的分布及耐药性变迁，对抗感染治疗和医院感染控制有积极意义。%Objective To study and analyze the distribution and drug resistance of pathogen of sputum sample of Neurosurgery patients so as to provide the basis for nosocomial infection monitory and rational drug use. Methods An Analysis of sputum culture identification and sensitivity test Results of Neurosurgery patients in our hospital from Jan. 2011 to Dec. 2013 has been made with the help of WHONET 5.4 Software. Results 753 copies of examined specimens and 344 strains isolated pathogen totally,in which,gram-negative bacteria 285 strains accounted for 82.8%, gram positive bacteria 31 strains accounted for 9.0%,and fungus 28 strains accounted for 8.2%. Neurosurgery patient was the high risk group of the multidrug resistance bacterial infection. The drug resistance of Acinetobacter baumannii to imipenem was deteriorate further(drugresistance rate>80%)Enterobacteriaceae showed a high sensitive to carbapenem drug,the detection rates of ESBL iolated from Escherichia coli and Klebsiella pneumoniae were 61.9% and 46.5%,respectively.Imipenem resist klebsiella pneumoniae was 3 strains,and the detection rate of MRSR was 58.9%. The staphylococcus which resisted by vancomycin was not detected. Conclusion The monitor of sputum culture of Neurosurgery patients in clinic should be strengthen,the bacterial examination rate should be increased,and the change of distribution and drug resistance of pathogen should be paid more attention to,so it has of value to prevent infection treatment and control infection in hospital.
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