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目的:了解颈脊髓损伤(CSCI)患者医院获得性肺炎(HAP)的发生情况及病原菌的分布特点和耐药情况。方法:2008年10月～2010年8月我院骨科监护病区(OICU)共收治CSCI患者123例,其中完全性损伤32例,不完全性损伤91例,C1～C4损伤51例,C5～C7损伤72例。回顾性分析本组患者HAP发生情况及其病原菌分布特点与耐药情况,并采用χ2检验比较CSCI平面、程度与HAP发生、再次感染及耐药菌感染的关系。结果:共33例(26.8%)患者出现51例次HAP,其中C1～C4 CSCI者的HAP发生率、再次感染率及多重耐药菌感染率分别为39.2%(20/51)、13.7%(7/51)、58.8%(30/51,按例次计算),C5～C7损伤患者分别为18.1%(13/72)、6.9%(5/72)、20.8%(15/72),C1～C4损伤者与C5～C7损伤者比较差异有统计学意义(P<0.05);完全性CSCI患者的HAP发生率、再次感染率及多重耐药菌感染率分别为56.3%(18/32)、28.1%(9/32)、68.8%(22/32,按例次计算),不完全性CSCI者分别为16.5%(15/91)、3.3%(3/91)、20.9%(19/91),两者比较差异有统计学意义(P<0.05)。33例(51例次)HAP患者痰标本中共分离出93株病原菌,其中革兰氏阴性(G-)杆菌占63.4%,主要为肺炎克雷伯菌(17.20%)、铜绿假单胞菌(15.05%)、大肠埃希菌(13.98%)、鲍曼不动杆菌(10.75%);革兰氏阳性(G+)球菌主要为金黄色葡萄球菌(8.60%);真菌主要为热带假丝酵母菌(8.60%)。G-杆菌和G+球菌普遍呈现多药耐药性,G-杆菌以碳青霉烯类敏感率最高,G+球菌对万古霉素均敏感。结论:CSCI患者HAP发生率较高,其发生率与CSCI平面及程度明显相关;病原菌以G-杆菌为主,常呈多药耐药。
Objective: To understand the occurrence of hospital acquired pneumonia (HAP) and the distribution of pathogenic bacteria and drug resistance in patients with cervical spinal cord injury (CSCI). Methods: From October 2008 to August 2010, 123 cases of CSCI were admitted to OICU, including 32 cases of complete injury, 91 cases of incomplete injury, 51 cases of C1-C4 injury, C7 injury in 72 cases. We retrospectively analyzed the incidence of HAP and the distribution characteristics and drug resistance of HAP in this group of patients. The relationship between the level of CSCI and the occurrence of HAP, re-infection and drug-resistant bacterial infection was compared using χ2 test. Results: A total of 51 HAPs were observed in 33 patients (26.8%). The HAP incidence, re-infection rate and multi-drug resistant rate of C1-C4 CSCI were 39.2% (20/51) and 13.7% (5/72), 20.8% (15/72), C1 (7/51), 58.8% (30/51, respectively) (P <0.05). The rates of HAP, re-infection and multi-drug resistant bacteria in patients with complete CSCI were 56.3% (18/32) , 28.1% (9/32) and 68.8% (22/32, respectively) with incomplete CSCI and 16.5% (15/91), 3.3% (3/91) and 20.9% 91), the difference between the two was statistically significant (P <0.05). Thirty-three pathogens were isolated from sputum samples from 33 HAP patients (51 cases), of which Gram-negative bacilli accounted for 63.4%, mainly Klebsiella pneumoniae (17.20%), Pseudomonas aeruginosa 15.05%), Escherichia coli (13.98%), Acinetobacter baumannii (10.75%), Staphylococcus aureus (8.60%) and Gram-positive bacteria (8.60%). G- and G + cocci generally showed multi-drug resistance, G- bacteria with carbapenem-sensitive, G + cocci were sensitive to vancomycin. CONCLUSIONS: The incidence of HAP in CSCI patients is high, and the incidence of CSAP is significantly related to the level and extent of CSCI. The pathogens are mainly G-bacilli and often show multi-drug resistance.