中枢神经系统感染患者脑脊液病原菌分布及耐药性分析

Distribution and drug resistance of pathogens isolated from cerebrospinal fluid of patients with central nervous system infections

目的了解中枢神经系统感染患者脑脊液病原菌的构成及耐药性,为临床使用抗菌药物提供依据。方法对2009年1月1日-2013年2月28日中枢神经系统感染患者送检的脑脊液标本,采用法国生物梅里埃公司生产的API鉴定试条进行病原菌鉴定,K-B纸片法测定病原菌药物敏感性,使用WHONET 5.5软件进行统计分析。结果从脑脊液标本分离出病原菌482株,其中革兰阳性菌248株占51.4%,革兰阴性菌212株占44.0%,真菌22株占4.6%;MRSA和MRCNS的检出率分别为82.4%和86.3%,未发现耐万古霉素金黄色葡萄球菌和肠球菌属;肺炎克雷伯菌、大肠埃希菌、阴沟肠杆菌对亚胺培南和美罗培南的耐药率为0。结论病原菌以革兰阳性菌为主,MRSA和MRCNS的检出率较高,鲍氏不动杆菌对常用抗菌药物表现为高度耐药和多药耐药,加强脑脊液病原学和耐药性监测,对指导临床合理应用抗菌药物具有重要意义。

OBJECTIVE To explore the distribution and drug resistance of the pathogens isolated from cerebrospinal fluid of the patients with central nervous system infections so as to provide guidance for clinical use of antibiotics . METHODS The submitted cerebrospinal fluid specimens were collected from the patients with central nervous sys-tem infections who were treated in the hospital from Jan 1 ,2009 to Feb 28 ,2013 ,then the identification of patho-gens was performed by using API identification strip ,the drug susceptibility was determined with the use of K-B disk method ,and the statistical analysis was performed by means of WHONET 5 .5 software .RESULTS A total of 482 strains of 482 strains of pathogens have been isolated from the cerebrospinal fluid specimens ,including 248 （51 .4% ） strains of gram-positive bacteria ,212 （44 .0% ） strains of gram-negative bacteria ,and 22 （4 .6% ） strains of fungi .The detection rate of MRSA and MRCNS were 82 .4% and 86 .3% ,respectively ;no vancomycin-resistant S .aureus or Enterococci was detected .The drug resistance rates of the K .pneumoniae ,E .coli ,and E . cloacae to imipenem and meropenem were 0 .CONCLUSION The gram-positive bacteria are the predominant patho-gens ;the detection rates of the MRSA and MRCNS are relatively high .The A .baumannii strains are highly re-sistant or multidrug-resistant to the commonly used antibiotics .It is of great significance to the reasonable clinical use of antibiotics to strengthen the etiological analysis of cerebrospinal fluid as well as the surveillance of drug re-sistance .