Clinical analysis of severe traumatic brain injury complicated by pulmonary infection

doi:10.3877/cma.j.issn.2095-9141.2021.03.004

Abstract

Abstract:

Objective

To investigate the clinical characteristics of patients with severe traumatic brain injury (sTBI) complicated with pulmonary infection.

Methods

Five hundred and twenty patients patients with sTBI treated in Neurosurgery Intensive Care Unit (ICU) of the First Affiliated Hospital, Air Force Military Medical University from March 2011 to October 2020 were analyzed retrospectively. According to the results of sputum culture and clinical diagnosis, the number of patients with pulmonary infection and infection strains were counted, and focus on the analysis of the dominant strains and their change rules from 2011 to 2020, as well as the impact of mixed infection and single-strain infection for hospital duration.

Results

Among the 520 patients with sTBI, 212 patients (40.8%) had lung infections. The strains consist mainly of Acinetobacter baumannii, Pseudomonas aeruginosa, meth-resistant Staphylococcus aureus (MRSA) and Klebsiella pneumoniae. The proportion of MRSA and Klebsiella pneumoniae has increased in recent years, and has a tendency to become dominant strains. The patients with pulmonary infection were hospitalized significantly longer than patients without pulmonary infection (Z=-13.127, P<0.001), and the hospital duration with mixed infection was remarkably longer than that with single-strain infection (Z=-6.919, P<0.001).

Conclusion

The strains and changes of pulmonary infections in patients with sTBI in ICU may be closely related to medical environmental health care, in addition, combined pulmonary infections, especially mixed infections, can significantly prolong the length of hospitalization.

Key words: Severe traumatic brain injury, Pulmonary infection, Mixed infection

Shuang Wu, Sanzhong Li, Xiuquan Wu, Yu Huan, Xin He, Jidong Sun, Wei Du, Xiaofan Jiang, Zhou Fei, Wei Lin. Clinical analysis of severe traumatic brain injury complicated by pulmonary infection[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(03): 141-145.

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References 25

[1]	Sharma R, Shultz SR, Robinson MJ, et al. Infections after a traumatic brain injury: the complex interplay between the immune and neurological systems[J]. Brain Behav Immun, 2019, 79: 63-74.
[2]	Jiang JY, Gao GY, Feng JF, et al. Traumatic brain injury in China[J]. Lancet Neurol, 2019, 18(3): 286-295.
[3]	Kesinger MR, Kumar RG, Wagner AK, et al. Hospital-acquired pneumonia is an independent predictor of poor global outcome in severe traumatic brain injury up to 5 years after discharge[J]. J Trauma Acute Care Surg, 2015, 78(2): 396-402.
[4]	《加重继发性脑损伤危险因素防治专家共识》专家组.颅脑创伤后加重继发性脑损伤的危险因素防治专家共识[J].临床神经外科杂志, 2020, 17(3): 241-249, 253.
[5]	张建宁.颅脑创伤后脑水肿机制的研究进展[J].中华神经创伤外科电子杂志, 2020, 6(5): 257-258.
[6]	Kourbeti IS, Papadakis JA, Neophytou C, et al. Infections in patients with traumatic brain injury who undergo neurosurgery[J]. Br J Neurosurg, 2011, 25(1): 9-15.
[7]	Kourbeti IS, Vakis AF, Papadakis JA, et al. Infections in traumatic brain injury patients[J]. Clin Microbiol Infect, 2012, 18(4): 359-364.
[8]	Kumar RG, Kesinger MR, Juengst SB, et al. Effects of hospital-acquired pneumonia on long-term recovery and hospital resource utilization following moderate to severe traumatic brain injury[J]. J Trauma Acute Care Surg, 2020, 88(4): 491-500.
[9]	黄超，黄庆华，尤荻,等.槲皮素在创伤性脑损伤治疗中潜在分子机制和临床应用的可行性[J].中国组织工程研究, 2019, 23(23): 3760-3766.
[10]	王长江，费爱丽，张慧,等. 480例颅脑损伤患者医院感染的病原菌耐药性与危险因素分析[J].医药导报, 2017, 36(9): 1047-1050.
[11]	熊丽，张莹，刘斌,等. 2012-2016年鄂州市中心医院重度颅脑损伤并发肺部感染病原菌的分布及其耐药性分析[J].现代药物与临床, 2018, 33(2): 421-426.
[12]	陈谦，任敬，郭再玉.急性出血性脑卒中开颅术后下呼吸道感染的危险因素及临床分析[J].中华脑科疾病与康复杂志(电子版), 2020, 10(6): 327-330.
[13]	吴宗宝，丁式行，李爱娟.鲍氏不动杆菌致呼吸机相关性肺炎54例分析[J].中华医院感染学杂志, 2004, 14(11): 1302-1304.
[14]	Dahyot-Fizelier C, Frasca D, Lasocki S, et al. Prevention of early ventilation-acquired pneumonia (VAP) in comatose brain-injured patients by a single dose of ceftriaxone: PROPHY-VAP study protocol, a multicentre, randomised, double-blind, placebo-controlled trial[J]. BMJ Open, 2018, 8(10): e021488.
[15]	许民.重型颅脑损伤合并MRSA感染的危险因素及护理对策[J].现代诊断与治疗, 2015, 26(20): 4783-4784.
[16]	Ahmad O, Crawford TN, Myint T. Comparing the outcomes of ceftaroline plus vancomycin or daptomycin combination therapy versus monotherapy in adults with complicated and prolonged methicillin-resistant staphylococcus aureus bacteremia initially treated with supplemental ceftaroline[J]. Infect Dis Ther, 2020, 9(1): 77-87.
[17]	刘思杰，鄂晓强，潘琦,等.关节置换后假体周围感染的规范化治疗[J].中国组织工程研究, 2019, 23(32): 5195-5202.
[18]	Jernigan JA, Hatfield KM, Wolford H, et al. Multidrug-resistant bacterial infections in U.S. Hospitalized patients, 2012-2017[J]. N Engl J Med, 2020, 382(14): 1309-1319.
[19]	吴本权，唐英春，朱家馨.医院内甲氧西林耐药金黄色葡萄球菌肺部感染高危因素分析[J].中华结核和呼吸杂志, 2000, 23(7): 413.
[20]	王媛媛，胡红霞，梁建红,等. ICU病区耐碳青霉烯类肺炎克雷伯菌的耐药及同源性特点分析[J].南京医科大学学报(自然科学版), 2020, 40(10): 1529-1533.
[21]	黄原，向尹，王燕玲,等.四川省9所医院2651株老年患者肺炎克雷伯菌的耐药率分析[J].现代预防医学, 2019, 46(14): 2680-2683.
[22]	陈鸣敏.耐甲氧西林金黄色葡萄球菌肺部感染相关因素分析[J].中华医院感染学杂志, 2012, 22(8): 1569-1571.
[23]	史庆丰，黄英男，孙伟,等.某综合医院重症监护病房耐碳青霉烯类肺炎克雷伯菌环境流行调查[J].中国感染控制杂志, 2020, 19(12): 1093-1097.
[24]	Menéndez R, Cremades MJ, Martínez-Moragón E, et al. Duration of length of stay in pneumonia: influence of clinical factors and hospital type[J]. Eur Respir J, 2003, 22(4): 643-648.
[25]	黄嘉炜，肖琴，吴建勇,等.广州市中老年社区获得性肺炎住院患者特征及住院时长的影响因素研究[J].中华流行病学杂志, 2017, 38(4): 542-546.

菌种	株(%)	感染率(%)	菌种	株(%)	感染率(%)
鲍曼不动杆菌	97(21.9)	45.8	表皮葡萄球菌	2(0.5)	0.9
铜绿假单胞菌	77(17.4)	36.3	反消化无色细菌	1(0.2)	0.5
耐甲氧西林金黄色葡萄球菌	64(14.4)	30.2	霉菌	1(0.2)	0.5
肺炎克雷伯菌	55(12.4)	25.9	嗜麦芽窄食单孢菌	1(0.2)	0.5
金黄色葡萄球菌	22(5.0)	10.4	产吲哚黄杆菌	1(0.2)	0.5
阴沟肠杆菌	22(5.0)	10.4	皱折假丝酵母菌	1(0.2)	0.5
大肠埃希菌	15(3.4)	7.1	黄杆菌属某些种	1(0.2)	0.5
粘质沙雷菌	15(3.4)	7.1	克氏（差异）柠檬酸杆菌	1(0.2)	0.5
肺炎克雷伯菌肺炎亚种	13(2.9)	6.1	流感嗜血杆菌	1(0.2)	0.5
纹带棒状杆菌	11(2.5)	5.2	木糖氧化产碱杆菌木糖亚种	1(0.2)	0.5
肺炎链球菌	6(1.4)	2.8	弗氏柠檬酸杆菌	1(0.2)	0.5
产气肠杆菌	5(1.1)	2.4	溶血不动杆菌	1(0.2)	0.5
粪肠球菌	5(1.1)	2.4	松鼠葡萄球菌	1(0.2)	0.5
产酸克雷伯氏菌	4(0.9)	1.9	盲肠肠球菌	1(0.2)	0.5
产酸克雷伯菌	4(0.9)	1.9	弗劳地狗氯酸杆菌	1(0.2)	0.5
奇异变形杆菌	3(0.7)	1.4	烟曲霉菌	1(0.2)	0.5
白色假丝酵母菌	2(0.5)	0.9	阿氏肠杆菌	1(0.2)	0.5
普通变形杆菌	2(0.5)	0.9	植生拉乌尔菌	1(0.2)	0.5
溶血葡萄球菌	2(0.5)	0.9

菌种	株(%)	感染率(%)	菌种	株(%)	感染率(%)
鲍曼不动杆菌	97(21.9)	45.8	表皮葡萄球菌	2(0.5)	0.9
铜绿假单胞菌	77(17.4)	36.3	反消化无色细菌	1(0.2)	0.5
耐甲氧西林金黄色葡萄球菌	64(14.4)	30.2	霉菌	1(0.2)	0.5
肺炎克雷伯菌	55(12.4)	25.9	嗜麦芽窄食单孢菌	1(0.2)	0.5
金黄色葡萄球菌	22(5.0)	10.4	产吲哚黄杆菌	1(0.2)	0.5
阴沟肠杆菌	22(5.0)	10.4	皱折假丝酵母菌	1(0.2)	0.5
大肠埃希菌	15(3.4)	7.1	黄杆菌属某些种	1(0.2)	0.5
粘质沙雷菌	15(3.4)	7.1	克氏（差异）柠檬酸杆菌	1(0.2)	0.5
肺炎克雷伯菌肺炎亚种	13(2.9)	6.1	流感嗜血杆菌	1(0.2)	0.5
纹带棒状杆菌	11(2.5)	5.2	木糖氧化产碱杆菌木糖亚种	1(0.2)	0.5
肺炎链球菌	6(1.4)	2.8	弗氏柠檬酸杆菌	1(0.2)	0.5
产气肠杆菌	5(1.1)	2.4	溶血不动杆菌	1(0.2)	0.5
粪肠球菌	5(1.1)	2.4	松鼠葡萄球菌	1(0.2)	0.5
产酸克雷伯氏菌	4(0.9)	1.9	盲肠肠球菌	1(0.2)	0.5
产酸克雷伯菌	4(0.9)	1.9	弗劳地狗氯酸杆菌	1(0.2)	0.5
奇异变形杆菌	3(0.7)	1.4	烟曲霉菌	1(0.2)	0.5
白色假丝酵母菌	2(0.5)	0.9	阿氏肠杆菌	1(0.2)	0.5
普通变形杆菌	2(0.5)	0.9	植生拉乌尔菌	1(0.2)	0.5
溶血葡萄球菌	2(0.5)	0.9

年份	菌株总数	鲍曼不动杆菌	铜绿假单胞菌	耐甲氧西林金黄色葡萄球菌	肺炎克雷伯菌
2011~2012	72	24(33.3)	22(30.6)	15(20.8)	11(15.3)
2013~2014	83	31(37.3)	17(20.5)	20(24.1)	15(18.1)
2015~2016	38	10(26.3)	12(31.6)	6(15.8)	10(26.3)
2017~2018	57	20(35.1)	20(35.1)	10(17.5)	7(12.3)
2019~2020	43	12(27.9)	6(14.0)	13(30.2)	12(27.9)
合计	293	97(33.1)	77(26.3)	64(21.8)	55(18.8)

年份	菌株总数	鲍曼不动杆菌	铜绿假单胞菌	耐甲氧西林金黄色葡萄球菌	肺炎克雷伯菌
2011~2012	72	24(33.3)	22(30.6)	15(20.8)	11(15.3)
2013~2014	83	31(37.3)	17(20.5)	20(24.1)	15(18.1)
2015~2016	38	10(26.3)	12(31.6)	6(15.8)	10(26.3)
2017~2018	57	20(35.1)	20(35.1)	10(17.5)	7(12.3)
2019~2020	43	12(27.9)	6(14.0)	13(30.2)	12(27.9)
合计	293	97(33.1)	77(26.3)	64(21.8)	55(18.8)

感染类型	例(%)	住院时长(d)
合并肺部感染	212(40.8)	18(11,29)
未合并肺部感染	308(59.2)	5(1,12)
Z值		-13.127
P值		<0.001

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