脑脊液病原菌变迁和耐药性分析

Changes and Resistance Analysis of Pathogens from Cerebrospinal Fluid

目的了解临床脑脊液培养阳性患者病原菌分布及其耐药情况。方法对2002-2008年临床脑脊液培养病原菌阳性患者标本进行回顾性统计分析;按常规方法进行细菌分离和鉴定;细菌药物敏感试验采用Kirby-Bauer纸片扩散法。结果分离出细菌97株,其中革兰阳性球菌占54.63%,革兰阴性菌占28.87%;新型隐球菌占13.40%。最常见的6种感染菌分别为凝固酶阴性葡萄球菌(40.21%)、不动杆菌属(8.25%)、铜绿假单胞菌(6.19%)、金黄色葡萄球菌(5.15%)、肺炎克雷伯菌(5.15%)、肠球菌属(5.15%);耐甲氧西林凝固酶阴性葡萄球菌(MRSCN)和耐甲氧西林金黄色葡萄球菌(MRSA)的检出率分别是89.7%和80.0%,细菌对常用抗生素耐药性较高,未见万古霉素耐药的葡萄球菌;美洛培南以及头孢哌酮/舒巴坦对革兰氏阴性杆菌有良好的抗菌活性。结论近6年来细菌性脑膜炎患者病原菌以革兰阳性球菌为主,主要为医院获得性细菌性脑膜炎感染。检出病原菌对常用抗生素耐药性较高,临床需警惕新型隐球菌的高发病趋势。

Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from cerebrospinal fluid （CSF）. Method All clinical pathogens isolated from cerebrospinal fluid （CSF） at hospital from 2002 to 2008 were analyzed by retrospective statistical technique. The pathogens were isolated and identified by routine method, and antibiotic sensitivity test were determined by Kirby-Bauer method. Result 97 strains of pathogens were isolated from CSF, of which gram-positive cocci was 54.63%, gram-negative bacteria was 28.87%, and cryptococcus neoforman was 13.40%. The 6 most common bacteria were isolated, of which the coagulase negative Staphylococci （CNS） was accounted for 40.21%, Acinetobacter spp 8.25%, pseudomonas aeruginosa 6.19%, Staphylococcus aureas 5.15%, Klebsiella pneumoniae 5.15% and Enterococcus 5.15%, and Methicillin-resistant S. aureus and Methicillin-resistant S.coagulase-negative were accounted for 80.0% and 89.7%, respectively. The pathogens had relatively high antibiotic resistance against antibiotics commonly used in clinic, and vancomycinresistant Staphylococci spp was not found. Meropeenem and cefoperazne/sul show high antimicrobial activity against gram negative bacterium. Conclusion The gram-positive cocci was the main pathogen which isolated from the CSF of patients with Bacterial Meningitis （BM） in recent 6 years, and BM was mainly hospital acquired. The pathogens isolated from the CSF had relatively high antibiotic resistance against antibiotics commonly used in clinic, and the rising trend of infection by cryptococcus neoforman should be worthy of watching out.