颅脑术后颅内葡萄球菌感染的临床分析

Clinical Analysis of Staphylococcic Infections After Craniotomy

目的分析颅脑术后颅内葡萄球菌感染的临床表现、危险因素、细菌耐药性特点，探讨预防措施及治疗方法。方法回顾性收集1999年9月至2007年9月山东大学齐鲁医院神经外科颅脑手术术后脑脊液培养证实葡萄球菌生长患者的资料，并进行统计学分析。结果本组共30例，男16例、女14例，年龄2—72岁，平均39．5岁。检出金黄色葡萄球菌1例，表皮葡萄球菌27例，溶血葡萄球菌4例，腐生葡萄球菌1例。合并两种以上细菌感染9例，其中7例为革兰氏阴性菌。颅内肿瘤术后感染11例，脑外伤5例，颅内置管性手术（脑室体外引流和脑脊液分流，其中2例为脑肿瘤患者）11例，颅内其他手术5例，其发生率分别为0．24％、0．64％、1．90％、0．69％，置管性手术组与肿瘤组及其他手术组相比有明显差异（P〈0．05）。耐甲氧西林葡萄球菌总体检出率为69．7％，未有耐万古霉素菌株出现。结论颅脑术后葡萄球菌脑膜炎以表皮葡萄球菌感染为主，好发于颅内置管性手术。耐甲氧西林菌株检出率呈逐年增高趋势，但万古霉素治疗效果仍可靠。

Objective To investigate the clinical manifestations, risk factors, bacterial resistance to drugs and evaluate prophylactic measures and therapy for staphylococcic meningitis associated with post-neurosurgical patients. Methods A retrospective study of the patients, who were performed neurosurgical operations between Sep, 1999 and Sep, 2007 in Qilu Hospital of Shandong University, was made. Staphylococcus was cultured from the cerebrospinal fluid of every case. Results There were 30 patients in this study ： 16 males, 14 females, age 2-72, mean age 39.5. The bacteria strains were isolated in thirty-three cases including 1 staphylococcus aureus, 27 staphylococcus epidermidis, 4 staphylococcus haemolyti- cus, and 1 Staphylococcus saprophyticus. Nine cases were infected by more than two bacteria, involving 7 Gram-negtive bateria. Eleven patients underwent operations for intracranial tumors, 5 for craniocerebral trauma, 11 for cerebrospinal fluid shunt or external ventrical drainage （ including 2 tumors ）, and 5 for other kinds of operations with the morbidity of 0. 24%, 0. 64%, 1.90%, and 0. 58%, respectively. There was significant difference in morbidity between the patients receiving external ventrical drainage and tumor operation or other operations （ P 〈 0. 05 ）. The total isolating rate of the methicilin resistant staphylococcus was 66. 7% and all of the cases were sensitive to vancomycin. Conclusious The staphylococci epidermidis is the predominant bacterial strain causing intracrartial staphylococcic meningitis after neurosurgical operations. There is a clearly predilection of staphylococcus for patients with cerebrospinal fluid shunt or external ventrical drainage. Although the annual isolation rate of the methicilin resistant staphylococcus stains is increasing, all isolated strains of staphylococcus are highly susceptible to vancomycin.