开颅手术后脑脊液培养病原菌分布及耐药性分析

Distribution and drug resistance of bacteria cultured from cerebrospinal fluid after cranioctomy

目的了解开颅手术后医院获得性细菌性脑膜炎的临床特征、病原菌分布和耐药性,指导临床合理选择抗菌药物。方法对2008-2010年100例住院患者开颅手术后脑脊液标本,分离细菌鉴定及药物敏感试验进行回顾性分析。结果 100例医院获得性脑膜炎分离病原菌中革兰阳性菌占42.0%;革兰阴性菌占53.0%;真菌占5.0%,最常见的6种病原菌依次为表皮葡萄球菌占30.0%、鲍氏不动杆菌占24.0%、肺炎克雷伯菌占15.0%、铜绿假单胞菌占8.0%、阴沟肠杆菌占5.0%和金黄色葡萄球菌占5.0%;其病原菌对常用抗菌药物普遍耐药;革兰阳性菌对利奈唑胺、替考拉宁、万古霉素敏感率为100.0%,革兰阴性菌对阿米卡星、美罗培南、哌拉西林/他唑巴坦、亚胺培南敏感率为100.0%,而对血脑屏障穿透力最强的头孢曲松均出现耐药株。结论颅脑术后患者分离病原菌以革兰阴性杆菌和葡萄球菌属为主,对常用抗菌药物普遍耐药,头孢曲松的耐药株的出现,使开颅手术后中枢神经系统感染的治疗面临巨大挑战,提示临床合理使用抗菌药物至关重要。

OBJECTIVE To investigate the bacteria distribution and drug resistance in cerebrospinal fluid of patients after cranioctomy in hospital,and to direct the doctor reasonably use of the antibacterial agents.METHODS Bacteria identification and drug susceptibility test of 100 strains separated from cerebrospinal fluid specimens of hospitalized patients were retrospectively analyzed from 2008 to 2010.RESULTS There were 100 strains isoleted from cerebrospinal fluid of patients after cranioctomy.The percentages of gram-positive bacteria,gram-negative bacteria,and fungus were 42.0%,53.0% and 5.0%,respectively.The prior six bacteria were Staphylococcus epidermidis（30.0%）,Acinetobacter baumannii（24.0%）,Klebsiella pneumoniae（15.0%）,Pseudomonas aeruginosa（8.0%）,Enterobacter cloacae（5.0%） and Staphylococcus aureus（5.0%）.All the bacteria were generally resistant to all the antibiotics by several degrees.The gram-positive bacteria were susceptible to vancomycin,linezolid and teicoplanin by 100%.The gram-negative bacteria were all susceptible to amikacin,meropenem,piperacillin/tazobactam and imipenem.There were several ceftriaxone resistant strains,which have the most penetrating ability to blood-brain barrier.CONCLUSION The dominant bacteria separated from cerebrospinal fluid of patients after craniotomy were the gram-negative bacteria and Staphylococcus,which were resistant to all the antibiotics.As the occurrence of ceftriaxone-resistant strains,the central nervous system infection after craniotomy for treatment become a great challenge,suggesting that rational use of anti-infection treatment with antibiotics is essential.