神经外科患者颅内感染病原菌分布及耐药性分析

Distribution and drug resistance of pathogens causing intracranial infections in patients of department of neurosurgery

目的探讨神经外科患者发生颅内感染病原菌分布及耐药性,为神经外科发生颅内感染的患者提供有效地治疗方法。方法回顾性分析2010年12月-2012年12月345例神经外科住院患者的临床资料,观察患者颅内感染发生率,并对发生感染患者的痰液、血液进行分离培养,细菌分离鉴定按《全国临床检验操作规程》进行常规操作,药敏试验采用K-B纸片法。结果 345例神经外科患者中有24例发生颅内感染,感染率为6.96%;感染患者送检标本共分离出病原菌35株,其中革兰阴性菌22株占62.86%,革兰阳性菌13株占37.14%;分布最多的病原菌分别为鲍氏不动杆菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌、大肠埃希菌,分别占25.71%、22.86%、14.29%、11.43%;革兰阴性菌中鲍氏不动杆菌对大部分抗菌药物耐药,而肺炎克雷伯菌对抗菌药物耐药率较低,平均为20.00%,而大肠埃希菌对美罗培南的耐药率为0,对阿米卡星耐药率为25.00%;金黄色葡萄球菌对万古霉素、左氧氟沙星、氯霉素敏感性均为100.00%;对青霉素耐药率为100.00%、对头孢曲松为50.00%。结论神经外科患者发生颅内感染的概率较高,以革兰阴性菌多见,主要病原菌的耐药严峻,临床需要进行相关监测,为颅内感染患者提供更好地治疗。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing intracranial infections in patients of department of neurosurgery so as to put forward effective measures for treatment of the intracranial infections. METHODS The clinical data of 345 patients who were hospitalized in the department of neurosurgery from Dec 2010 to Dec 2012 were retrospectively analyzed, then the incidence of intracranial infections was observed, the sputum specimens and blood specimens obtained from the patients with infections were cultured, the isolation and identification of bacteria were performed according to the National clinical laboratory procedures, and the drug susceptibility testing was conducted with the use of K-B disk method. RESULTS Of the 345 patients in the department of neurosurgery, the intracranial infections occurred in 24 cases with the incidence rate of 6.96%. A total of 35 strains of pathogens have been isolated from submitted samples, including 22 （62. 86%） strains of gram-negative bacteria and 13 （37. 14./00） strains of gram-positive bacteria the Acinetobacter baumannii, coagulase-negative Staphylococci, Klebsiella pneumoniae, and Escherichia coli were the most common species of pathogens, accounting for 25.71, 22. 860/00, 14. 29, and 11. 430//00, respectively. Among the gram-negative bacteria, the A. baumannii strains were resistant to most of the antibiotics, the drug resistance rates of the K. pneumoniae strains to the common antibiotics were low, with the average of 20.00, the drug resistance rate of the E. coli strains to meropenem was 0, amikacin 25.00 ; the drug resistance rates of the Staphylococcus aureus strains to vancomycin, levofloxacin, and chloromycetin were 100.00, the drug resistance rate to penicillin was 100.00, ceftriaxone 50.00. CONCLUSION The incidence of intraeranial infections is high in the patients of department of neurosurgery; the gram-negative bacteria are very common the main species of pathogens arehighlyresistant; it is necessary for the hospital to strengthen related surveillance so as to offer better treatment for the patients with intracranial infections.