| Backgrounds: Recently, with the wide use of the broad-spectrum antimicrobial agents, the variety, illness causing degree and drug sensitivity of pathogenic bacteria have changed greatly and bacterium of anti-medicine are increasing, which bring new challenges to clinic treatment, especially the anti-medicine infection in the hospital has increased the death rate of the patients. The ESBL_s Strains is a kind of hydrolytic penicillin, cephalosporin and monocyclic antibiotic which can conductβ-lactamases that bacterium have medicine resistance to the antibiotic. With the wide use of the third generation Cephalosporins, the ESBL_s infection has been increasing even broken out and spread seriously in some areas and hospitals, which become an important factor for the nosocomial infection, and the disease is a difficult problem in clinic treatment. The Neurosurgery Department always takes prevention and infection control as an important part of Complex Treatment, so knowing about the distribution and medicine resistance of main pathogenic bacterium of the nosocomial infection in neurosurgery and the characteristic of Produced ESBL_s Strains has an instructive meaning to instruct doctors in choosing the antibacterial to cure the infection diseases, reduce infection rates in hospitals and control the spread of medicine resistance of bacterium; so produced ESBL_s Strains infection can be prevented from efficiently, diagnosed earlier and got complex treatment.Objective: the study on the distribution and medicine resistance of main pathogenic bacterium of the nosocomial infection in neurosurgery and the characteristics of Produced ESBL_s Strains so as to provide the basis for clinic treatment. Materials and methods: The patients in the neurosurgery of Zhengzhou the Second Hospital from January, 2003 to December 2005 and the patients in Common Surgery, Urinary Surgery and Orthopaedics and so on from January 2005 and December 2005. We have checked 5,675 clinic medical records. From Jan 2003 to Dec 2005, total 408 strains pathogens were separated from the samples of cerebrospinal fluid, sputum, blood, urine and wound secretion.Study methods: To analyze 5675 cases of illness according to the Nosocomial Infection and Diagnostic Standard and investigate the pathogen with the references of bacteria test report. To separate clinic specimen by routine method and make a medicine allergy analysis by the method of French bioMerieux ATB express automatic identification of bacteria and medicine allergy system evaluation strain procedures. To judge the result based on the standards issued by NCCLS in 1999. After the examination of primary screening test and phenotype verification experiment, to make aβ-lactamases test to decide the produced ESBLs strains.Data analysis methods: To record the data by Excel and change database into SAS dataset and make a statistical analysis by SAS9.13 software. The infection rates of different departments and bacteria kinds and the distribution comparison of pathogenic bacteria tested adopts x~2 or extract probabilistic method. The change trend in different years adopts Cochran - Armitage trend test.Results:1. The average nosocomial infection rate in neurosurgery from 2003 to 2005 is7.64%, by the comparison between the yearly infection rates happened in hospital, the result shows that there are no obvious differences between the years ( x~2 =3.25, p>0.05) . The infection rate in neurosurgery is 6.56% in 2005,by comparison between 4 departments of Neurosurgery, Common Surgery, Urinary Surgery and Orthopaedics, there are no obvious differences in the four departments (x~2=2.65,P>0.05) .2. There are 408 strains separated from 281 patients in Neurosurgery, of which, gram-negative bacteria is 77.2% and gram- positive bacteria is 22.8%. The investigation has nothing to do with fungus and anaerobic bacteria. The most common strains are Pseudomonas aeruginosa (93 strains, 22.8%), Eschetichia coli (80 strains, 19.6%), klebsiellar pneumonia (52 strains, 12.7%),Acinetobacter (50 strains, 12.3%),Staphylococcus aureaus (50 strains, 12.3%),Coliform (30 strains, 7.4%), coagulase-negative Staphy-lococcus (CNS) ) (17 strains, 4.2%), enterococcus(17 strains,4.2% ), stenotrophomo-nas maltophilia (10 strains, 2.5%),streptococcus pneumoniae (9 strains,2.2%). With the comparison of quality separated from different pathogenic bacteria samples, the result shows the proportion of different pathogenic bacteria in different samples is different and the difference has the significance in statistics ( x~2 =118.59,p<0.05) . In 2005, main pathogenetic bacteria of surgery system include escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureaus. The infection disease bacteria distribution in four departments is not the same completely ( x~2 =34.96, p<0.05), among which, the infection disease bacteria distribution in Neurosurgery and Common Surgery is greatly different and that of neurosurgery and urination surgery is greatly different(x~2 neurosurgery: common surgery =25.46,x~2 neurosurgery : urination surgery =13.93,p<0.05); the infection disease bacteria distribution in other departments has no obvious differences (x~2 neurosurgery: orthopaedics=8.00, x~2 common surgery: orthopaedics =3.27, x~2 common surgery: urination surgery=4.40, x~2 orthopaedics: urination surgery=4.96,p>0.05).3. The separated bacteria resistance in Neurosurgery is serious. G- Bacteria has strong resistance against most common Cephalosporins, for example, the sensitivity rate against Ceftazidime is 44.6% and the sensitivity rate against Imipenem-Cilastatin is 93.7%. G~+ Bacteria has basic resistance against penicillin antibiotics and the sensitivity rate against vancomycin is only 80.6%. With the comparison of the use rate of the third generation cephalosporin antibiotics from 2003 to 2005, the cephalosporin use rate in different years has the significance in statistics (x~2 =74.18, p<0.05). After the trend test of Cochran-Armitage, the result shows T=8.61, p<0.05 and the use proportion by the patients in hospital is increasing year after year according the use proportion increasing year after year.4. Separate to produce ESBLs 36 strains, occupying 8.8% of the total, of which, 18 Eschetichia coli, 12 Acinetobacter and 6 klebsiellar pneumonia. after the test in statistics indicates: the proportion of the number of strains of produced ESBLs from 2003 to 2005 in total stains number is not the same yearly and the differences have the significance in statistics ( x~2 =16.84,p<0.05) , besides, after the trend test of Cochran-Armitage, the result shows T=8.61, p<0.05 , namely, the annual proportion of produced Strains in the total stains is increasing year after year.5. The resistances of 36 produced ESBLs Strains against Ceftazidime, Ceftriaxone and Cefotaxime are 100%, 83.3%, 88.9% respectively; the resistances against aminobenzylpenicilin, piperacillin, amoxicillin/clavulanic acid and amoxicillin/ Sulbactam are 100%, 91.7%, 91.7% and 33.3% respectively; the resistance against Amikacin is 58.3%; The resistance against Ciprofloxacin is 75.0% and the resistance against Imipenem-Cilastatin is zero.Conclusions:G Bacteria is the main bacteria in Neurosurgery ; the resistance of bacteria is strong widely; the wide use of the third generation cephalosporin antibiotics is the important choice factor for the production of ESBLs by the bacteria; the prevention of bacteria resistance must be conducted and adopt comprehensive methods to build bacteria resistance monitoring system, carry out the training of the relative knowledge and universal education and use bacteriophage reasonably so as to control or delay the resistance.
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