神经外科ICU耐药鲍曼不动杆菌颅内感染的治疗

Treatment of intracranial infection due to drug - resistant Acinetobacter Baumannii in neurosurgical

目的探讨神经外科ICU耐药鲍曼不动杆菌颅内感染的治疗方案。方法对南方医科大学南方医院神经外科重症监护病房（NSICU）收治的鲍曼不动杆菌颅内感染13例的临床资料进行回顾性分析，包括一般情况、原发疾病、感染部位、感染原因、药物敏感性、治疗方案及治疗结果。结果13例均为耐药鲍曼不动杆菌感染，脑膜炎4例，脑室炎9例；感染原因：脑脊液切口漏7例，脑室外引流3例，血流感染逆行2例，腰大池引流1例；多重耐药（MDRAB）4例，泛耐药（XDRAB）9例；治愈率61．5％，病死率38．5％，其中MDRAB治愈率100％，XDRAB病死率55．6％。结论神经外科ICU耐药鲍曼不动杆菌颅内感染病死率高，切口脑脊液漏和脑室外引流是主要的感染原因，脑脊液引流通畅和合理选择抗生素是成功治愈的关键，MDRAB基于美罗培南的联合治疗和XDRAB基于多粘菌素或替加环素联合舒巴坦钠的治疗能提高治愈率。

Objective To explore the treatment of intracranial infection due to drug - resistant Acinetobacter Baumannii in neurosurgical ICU. Methods The clinical data, including general status, primary diseases, infection sites, infection causes, drug sensitivity, therapeutic strategies and therapeutic effects, of 13 cases of intracranial infection due to drug- resistant Acinetobacter Baumannii in neurosurgical ICU （NSICU） of our hospital were retrospectively analyzed. Results The 13 cases, including 4 cases of meningitis and 9 cases of ventriculitis, were all infected by drug - resistant Acinetobacter Baumannii. The causes of infection included 7 cases of CSF leakage, 3 external ventricular drainage, 2 retrograde hematogenous infection, and 1 lumbar cistern drainage. There were 4 cases of multi - drug resistant Acinetobacter Baumannii （MDRAB） and 9 cases of extensively drug resistant Acinetobacter Baumannii （XDRAB）. The curative rate and mortality rate was 61.5% and 38.5%, respectively. The curative rate of MDRAB was 100%, while the mortality rate of XDRAB was 55.6%. Conclusions The mortality rate of intracranial infection due to drug- resistant Acinetobacter Baumannii in NSICU was high. The main causes of infection were CSF leakage of incision and external ventricular drainage. Effective CSF drainage and reasonable choice of antibiotics were the keypoints for successful treatment. Combined treatment based on Meropenem for MDRAB, and treatment based on Polymyxin or Tigecycline combined with Sulbactam sodium for XDRAB could raise the curative rate.