CAJ | 학술논문

目的：分析脊髓损伤患者医院感染的部位、菌株构成和耐药情况，为临床治疗和抗生素的合理应用提供科学依据。方法选取2012年6月~2013年12月本院收治的395例脊髓损伤患者为研究对象，对感染部位细菌学和耐药情况进行分析。结果132例脊髓损伤患者发生医院感染。主要部位为泌尿道(71.1%)和下呼吸道(24.2%)。主要致病菌是大肠埃希菌(45.6%)、铜绿假单胞菌(18.1%)、肺炎克雷伯杆菌(11.4%)和奇异变形杆菌(8.7%)；致病菌对第二、三代头孢类抗生素和喹诺酮类呈中高度耐药，而对含β-内酰胺酶抑制剂的复方制剂和氨基糖苷类较敏感。结论脊髓损伤患者医院感染的部位多为泌尿道和呼吸道，致病菌以革兰阴性杆菌为主。致病菌有较强的耐药性，临床应根据细菌培养和药敏实验结果，合理选择抗生素，并根据PK/PD(药动学/药效学)理论优化抗菌药物治疗方案。
목적：분석척수손상환자의원감염적부위、균주구성화내약정황，위림상치료화항생소적합리응용제공과학의거。방법선취2012년6월~2013년12월본원수치적395례척수손상환자위연구대상，대감염부위세균학화내약정황진행분석。결과132례척수손상환자발생의원감염。주요부위위비뇨도(71.1%)화하호흡도(24.2%)。주요치병균시대장애희균(45.6%)、동록가단포균(18.1%)、폐염극뢰백간균(11.4%)화기이변형간균(8.7%)；치병균대제이、삼대두포류항생소화규낙동류정중고도내약，이대함β-내선알매억제제적복방제제화안기당감류교민감。결론척수손상환자의원감염적부위다위비뇨도화호흡도，치병균이혁란음성간균위주。치병균유교강적내약성，림상응근거세균배양화약민실험결과，합리선택항생소，병근거PK/PD(약동학/약효학)이론우화항균약물치료방안。
Objective To pave the way for clinical therapy and reasonable administration of antibiotics, and to analyze the kinds and drug-resistance of pathogens of nosocomial infection in patients with spinal cord injury. Methods Bacteriology of infection and drug resis-tance were analyzed in 395 patients with spinal cord injury in the hospital from Jun., 2012 to Dec., 2013. Results There were 132 cases with nosocomial infection. Most of the infections were found in urinary tract (71.1%) and lower respiratory tract (24.2%). The main pathogenic germs were Escherichia coli (45.6%), P. Aeruginosa (18.1%), K. pneumonia (11.4%) and P. mirabilis(8.7%), which were resistant to the sec-ond or third generation cephalosporins and quinolones moderately or severely, but sensitive toβ-lactamase inhibitor combinations and ami-noglycosides. Conclusion The main pathogenic bacteria in nosocomial infection of patients with spinal cord injury are G-bacilli. The bacte-ria are resistant moderately or severely to antibiotics, which should be selected rationally by bacterial culture and drug susceptibility test, and optimized rationally with PK/PD (pharmacokinetics and pharmacodynamics).