目的 了解鄂州市中心醫(yī)院重度顱腦損傷并發(fā)肺部感染病原菌的分布及其耐藥性。方法 收集2012—2016年鄂州市中心醫(yī)院重度顱腦損傷并發(fā)肺部感染患者（378例）的臨床資料，對其感染病原菌的分布、感染類型及耐藥性進(jìn)行分析。結(jié)果 378例患者中共分離出病原菌611株，革蘭陰性菌448株（67.78%），革蘭陽性菌201株（30.41%），真菌12株（1.82%）。378例患者中，126例（33.33%）分離出單一病原菌，主要為銅綠假單胞菌、金黃色葡萄球菌、鮑曼不動桿菌等；221例（58.46%）分離出兩種病原菌，主要為銅綠假單胞菌+鮑曼不動桿菌、大腸埃希菌+肺炎克雷桿菌、鮑曼不動桿菌+大腸埃希菌；31例（8.20%）分離出三種病原菌，主要為鮑曼不動桿菌+肺炎鏈球菌+白色念珠菌、肺炎克雷桿菌+陰溝腸桿菌+溶血性葡萄球菌、鮑曼不動桿菌+肺炎克雷桿菌+大腸埃希菌。藥敏結(jié)果顯示，革蘭陰性菌對大部分抗菌藥物耐藥，鮑曼不動桿菌對頭孢哌酮鈉舒巴坦、阿米卡星的耐藥率較低，銅綠假單胞菌、大腸埃希菌、肺炎克雷伯桿菌等對亞胺培南、美羅培南、頭孢他啶和頭孢哌酮鈉舒巴坦的耐藥率較低；革蘭陽性菌對萬古霉素、替考拉寧、利奈唑胺的耐藥率低。結(jié)論 重度顱腦損傷并發(fā)肺部感染病原菌以革蘭陰性菌混合感染為主，藥敏提示對大多數(shù)抗菌藥物耐藥。臨床治療中應(yīng)加強(qiáng)臨床病原菌的監(jiān)測，合理選用抗菌藥物、及時(shí)控制感染。

Objective To understand the distribution and drug resistance of pathogenic bacteria from patients with severe craniocerebral injury complicated with pulmonary infection in Ezhou Central Hospital. Methods The clinical data of patients (378 cases) with severe craniocerebral injury complicated with pulmonary infection in Ezhou Central Hospital from 2012 to 2016 were enrolled. The pathogen distribution, infection type, and drug resistance were analyzed. Results There were 661 strains of pathogens identified in 378 patients, including 448 strains of Gram-negative bacteria (67.78%), 201 strains of Gram-positive bacteria (30.41%), and 12 strains of Fungi (1.82%). There were 126 patients (33.33%) who identified one pathogen in 378 patients, mainly Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii and so on; and 221 patients (58.46%) identified two pathogens, mainly P. aeruginosa + A. baumannii, Escherichia coli + Klebsiella pneumoniae, A. baumannii + E. coli; and 31 patients (8.20%) identified three pathogens, mainly A. baumannii + Streptococcus pneumoniae + Candida albicans, K. pneumoniae + Enterobacter cloacae Staphylococcus haemolyticus, A. baumannii + K. pneumoniae + E. coli. Drug sensitivity showed that Gram-negative bacteria were resistant to most antimicrobial agents. A. baumannii was the less resistant to cefoperazone/sulbactam and amikacin. The drug resistance rate of P. aeruginosa, E. coli, and K. pneumoniae against imipenem, meropenem, ceftazidime, and cefoperazone/sulbactam was lower. The drug resistance rate of Gram-positive bacteria against vancomycin, teicoplanin, and linezolid was lower. Conclusion Severe craniocerebral injury complicated with pulmonary infection is mainly caused by mixed infection of Gram-negative bacteria. Drug sensitivity is resistant to most antimicrobial agents. The monitoring of clinical pathogens should be strengthened in clinical treatment. Antimicrobial drugs should be chosen reasonably, timely control of infection.