摘要目的 探讨亚胺培南-西司他汀钠初始经验性治疗神经外科重症患者气管切开后下呼吸道感染的临床效果.方法 神经外科重症气管切开后下呼吸道感染患者32例,采用亚胺培南-西司他汀钠进行初始经验性用药,并对该类气管切开术后患者的痰液进行培养及药物敏感性试验,治疗结束时观察临床效果.结果 32份痰标本中检出细菌48株,真菌5株;单一感染15株,混合感染38株;以G-杆菌为主(64.1%),其次为G+球菌(26.4%)和真菌(9.4%).药敏试验结果示,G-杆菌对亚胺培南高度敏感,对氨苄西林、庆大霉素高度耐药,葡萄球菌属对呋喃妥因、利福平敏感率较高,未发现耐万古霉素的G+球菌.所有患者经亚胺培南-西司他汀钠经验性治疗后根据药敏结果针对性应用抗生素进行感染治疗,有效率100%.结论 神经外科重症患者气管切开后下呼吸道感染的病原菌以G-杆菌为主,G+球菌感染以金黄色葡萄球菌为主,该类患者经亚胺培南-西司他汀钠的经验性治疗可有效控制其相应感染.

abstractsObjective To investigate the clinical curative effect of Prepenem for pathogen from cranial neu-rosurgieal patients with lower respiratory tract infection after traeheotomy and to provide basis for treatment of such pa-tients. Methods Thirty-two cranial neurosurgical patients with lower respiratory tract infection after tracheotomy were enrolled in the study with original empiric therapy with Prepenem. And the pathogenic bacteria in sputum from patients with lower respiratory tract infection after traeheotomy were stricdy identified and analyzed by automatic mi-croorganism analyzers. The clinical efficacy of Prepenem was identified after treatment. Results The straim of bacte-rial species(48) and funni(5) from 32 specimens were isolated. 15 strains were infected by one kind of bacteria and 38 strains were infected by two kinds of bacteria. Among the pathogen, gram-negative bacilli were about 64. 1% and Klebsiela pneumoniae (18. 8%)was the most predominant, gram-positive coccobacteria were about 26. 4% and Staph-ylococcus aureus(13.2%)was the most predominant,funni were about 9.4% and C. albicans (5.7%)was the most predominant. The drug sensitivity test showed that the ratio of drug resistance of bacteria isolated from sputum was high,but gram-negative bacilli were highly sensitive to imipenem. Staphylococcus aurens was sensitive to Nitrofuran-toin and Rifampicin. Satisfied clinical curative effect was shown by the de-escalation therapy for all patients. Conclu-sions Gram-negative bacili in cranial neurosurgical patients with lower respiratory tract infection after tracheotomy are the main pathogenic bacteria from lower respiratory tract infection, and Staphylococcus aureus are the main gram-positive cocci. So the drug sensitivity test of sputum should be done more often and antibiotics must be selected ac-cording to the drug sensitivity test. In general, this kind of infection can be controlled by prepenem effectively.