| Objective:To analyze the epidemiological data of nosocomial infection in neurocritical patients,to understand the incidence of nosocomial infection in neurocritical patients,the distribution of infection,the occurrence of drug-resistant bacteria and their impact on prognosis,to provide some basis for the prevention and control of nosocomial infection,diagnosis and rational application of antibiotics in neurocritical patients.Methods:To collect the clinical data of neurocritical patients in the Intensive care unit(Comprehensive ICU)of the affiliated Hospital of Guizhou Medical University from January 2018 to December 2021,retrospective analysis of nosocomial infection incidence,infection distribution,types of pathogens,proportion of multidrug-resistant bacteria and drug sensitivity in patients with neurocritical patients.The samples from January 2018 to December 2019 were marked as group 1,and the samples from January 2020 to December 2021were marked as group 2,to observe the changes of main pathogens,drug resistance and drug sensitivity of nosocomial infection in two time periods.At the same time,the length of stay in ICU,mechanical ventilation time and mortality of patients with nosocomial infection were observed,comparison of prognosis between patients with multidrug-resistant bacterial infection and patients with non-multidrug-resistant bacterial infection,and the prognosis of patients with different multidrug-resistant bacteria infection.Results:From January 2018 to December 2021,1325 neurocritical patients were treated in the Intensive care unit(Comprehensive ICU)of the affiliated Hospital of Guizhou Medical University,the incidence of nosocomial infection was 24.75%(328/1325);among them,patients with multi-drug resistant bacteria infection accounted for 56.4%(185/328),patients with non-multidrug resistant bacteria infection accounted for 43.6%(143/328);a total of 2315 samples were submitted for examination in 328 patients,the detection rate of pathogenic bacteria in sputum samples was 32.76%(325/992);the detection rate of blood samples was 19.28%(145/752);the detection rate of urine samples was 31.6%(81/256);the detection rate of cerebrospinal fluid samples was 20.99%(34/162);the detection rate of central catheter samples was 23.75%(19/80);the detection rate of wound secretion samples was17.81%(13/73).A total of 617 strains of pathogenic bacteria were detected,excluding the same strains cultured from the same patient,421 strains of pathogenic bacteria were included in the statistics,There are mainly 332strains of Gram-negative bacteria(78.86%),mainly Klebsiella pneumoniae and Acinetobacter baumannii;followed by 60 strains of Gram-positive bacteria(14.25%),mainly Enterococcus faecium and Staphylococcus aureus;there are29 strains of fungi(6.89%).The main site of infection was pulmonary infection,accounting for 57.48%(242/421).The main pathogens of pulmonary infection were Klebsiella pneumoniae and Acinetobacter baumannii;the main pathogens of bloodstream infection were Klebsiella pneumoniae and Staphylococcus epidermidis;the main pathogens of urinary tract infection were Enterococcus faecium and Escherichia coli.The top five bacteria from January 2018 to December 2019 were Acinetobacter baumannii,Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa and Staphylococcus aureus;The top five bacteria from January 2020 to December 2021 were Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa,Escherichia coli and Enterococcus faecium.The resistance rate of Klebsiella pneumoniae to ceftazidime and cefepime was 72.78%,the resistance rate of ceftriaxone was77.85%,the drug resistance rate of cefotaxime was 75.31%,the resistance rate of meropenem was 51.84%,the resistance rate of meropenem was 51.84%,the resistance rate of ertapenem was 44.65%,the resistance rate of imipenem was46.93%,Polymyxin is completely sensitive,the resistance rate of ceftazidime to avertam was 2.13%.Compared with the two groups,the resistance rate of Klebsiella pneumoniae to sulfamethoxazole increased(group 1:32.35%,group2:57.45%),the difference is statistically significant(χ~2=4.988,P=0.026),the resistance rate of tigecycline increased(group 1:17.65%,group 2:44.68%),the difference is statistically significant(χ~2=6.488,P=0.011).The resistance rate of Acinetobacter baumannii to carbapenems were 87.14%,the resistance rate of ceftazidime was 89.52%,the resistance rate of ceftriaxone was 88.57%,the resistance rate of cefotaxime and cefepime was 87.38%,Polymyxin was completely sensitive,the resistance rate of ceftazidime to avertam was 2.38%.Comparing the resistance rates of the two groups,the resistance rate of Acinetobacter baumannii to tigecycline increased(group 1:8.57%,group 2:28.57%),the difference is statistically significant(χ~2=4.868,P=0.027),the resistance rate to tobramycin increased(group 1:74.29%,group 2:92.86%),the difference is statistically significant(χ~2=5.005,P=0.025).The resistance rate of Pseudomonas aeruginosa to tigecycline were 74.24%,the resistance rate of amikacin was 38.18%,the resistance rate of meropenem and imipenem was 31.51%.The resistance rate of Escherichia coli to amikacin were 7.18%,the resistance rates of meropenem,imipenem and piperacillin tazobactam were11.02%,the resistance rate of ertapenem was 18.20%,the resistance rate of tigecycline was 3.84%,Enterococcus faecium was completely sensitive to vancomycin and linezolid.Analysis of general data showed that GCS score was correlated with multidrug-resistant bacteria in neurocritical nosocomial infection(P<0.05);According to the analysis of prognostic indicators,the time of mechanical ventilation in neurocritical patients with multidrug-resistant bacteria in nosocomial infection was significantly longer than that in patients with non-multidrug-resistant bacteria(P<0.05),the 30-day and 90-day fatality rate increased significantly(P<0.05).There was no significant difference in the length of stay in the comprehensive ICU,the time of mechanical ventilation and the mortality among patients with multidrug-resistant bacteria infection(P>0.05).Conclusions:1.The incidence of nosocomial infection in neurocritical patients was24.75%,multiple drug-resistant bacteria accounted for 56.4%of nosocomial infection,the main pathogens are Gram-negative bacilli,mainly Klebsiella pneumoniae and Acinetobacter baumannii,and the main infection site was respiratory tract.2.The main multi-drug resistant bacteria detected in neurological severe patients were CRKP and CRAB,the resistance rate of two kinds of bacteria to tegacycline increased,but they were still sensitive to polymyxin,Ceftazidime and avertam.3.Nosocomial infection with multiple drug-resistant bacteria can increase the time of mechanical ventilation and 30-day,90-day mortality in neurocritical patients. |
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