1997～2010年某院神经外科患者脑脊液分离菌及其耐药性研究

Antimicrobial susceptibility of bacteria isolated from cerebrospinal fluid of neurosurgical patients in Beijing Tiantan Hospital,Capital Medical University from 1997 to 2010

目的监测神经外科患者脑脊液致病菌流行病学分布及耐药情况。方法收集首都医科大学附属北京天坛医院神经外科1997年8月至2010年12月所送检的脑脊液标本。分离致病菌并行药敏鉴定,统计致病菌的分布和抗菌药物的敏感率。结果本研究共分离致病菌1778株,其中革兰阳性球菌1249株(70%);革兰阴性杆菌529株(30%)。位居前6位的致病菌分别为:凝固酶阴性葡萄球菌(57%),金黄色葡萄球菌(9%),鲍曼不动杆菌(6%),肠球菌属(5%),洛菲不动杆菌(4%)和肠杆菌属(4%)。其中鲍曼不动杆菌,肠球菌属增长迅速,肠杆菌属是惟一分离比例下降的革兰阴性杆菌。耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)的检出率分别为79%和86%,葡萄球菌属中未发现万古霉素耐药株。肠球菌属中有少数万古霉素耐药株(30%)。肠杆菌属细菌对碳青霉烯类药物高度敏感。鲍曼不动杆菌耐药较严重,2006年10月至2010年12月其药物敏感性均<33%,阿米卡星的敏感性为33%,亚胺培南的敏感性自100%下降到28%。多种药物对洛菲不动杆菌的敏感性>75%。铜绿假单胞菌的敏感性分别为:阿米卡星(84%),哌拉西林+他唑巴坦(82%),亚胺培南(78%),头孢他啶(76%),依然维持着稳定的敏感性。肠杆菌属耐药也较为严重,2006年10月至2010年12月,按照其药物敏感性由高到低顺序依次为亚胺培南(91%)、磺胺类药物(76%)、加替沙星(71%)、阿米卡星(67%)和庆大霉素(62%)。结论神经外科患者颅内感染以革兰阳性球菌多见,尤其是凝固酶阴性葡萄球菌和金黄色葡萄球菌;脑脊液分离株对常用抗菌药物耐药明显。

Objective To investigate the distribution and antibiotic resistance of bacteria isolated from cerebral spinal fluid （CSF） of neurosurgical patients. Methods The data of bacteria isolated from CSF in our hospital were collected from August 1997 to December 2010. Distribution and antibiotic resistance of bacteria were analyzed, retrospectively. Results Among 1778 isolates, Gram positive cocci and Gram negative bacilli accounted for 70% （1249 isolates） and 30% （529 isolates） , respectively. The most frequently isolated bacteria was coagulasenegative staphylococci （57%）, followed by Staphylococcus aureus （ 9% ）, Acinetobacter spp. （ 6% ）, Enterococcus spp. （ 5% ）, Acinetobacter lwoffii （ 4% ） and Enterobaeter spp. （4%）. In these years, Acinetobacter spp. increased rapidly and Enterobacter spp. decreased. No Staphylococcus aureus resistant to Vaneomycin was found. Methieillin-resistant Staphylococcus aureus （MRSA） and methicillin resistant coagulase negative Staphylococci （MRCNS） accounted for 79% and 86%, respectively. Thirty percent of Enterococcus spp. resistant to Vancomycin. Aeinetobacter spp. was highly susceptive to Carbapenems. The susceptility of Acinetobacter spp. to amikaein was 33%, and to imipenem dropped from 100% to 28% during 2006 to 2010. Suseeptility of Acinetobacter lwoffii to most antibiotics were more than 75%. For Pseudomonas aeruginosa, the susceptility to amikacin was 84%, followed by Piperacillin/sulbactam （82%）, Imipenem （78%） and Ceftazidime （76%）. For Acinetobacter spp, the susceptility to Imipenem was 91%, followed by Sulfonamides （76%）, Gatifloxacin （67%） and Gentamicins （62%）. Conclusions Gram positive cocc were much more common in neurosurgical patients, especially Coagulasenegative staphylococci and Staphylococcus aureus. The antibiotic resistance of bacteria should be paid more attention to.