脑室-腹腔分流术患者反复感染的病原学分析与临床治疗研究

Etiological analysis of recurrent infections in patients undergoing ventricle-peritoneal shunt and clinical treatment

目的探讨脑室-腹腔分流术反复感染的病原菌与耐药性,以寻找最敏感的抗菌药物对症治疗,提高临床治疗水平。方法选取2007年1月-2013年1月130例脑室-腹腔分流术反复感染患者为研究对象,对所有患者进行病原菌与耐药性分析。结果分离出病原菌155株,其中革兰阴性菌占34.19%,革兰阳性菌占52.26%,真菌占13.55%;革兰阳性菌中耐药性较低的抗菌药物有亚胺培南、美罗培南,均为0,在革兰阴性菌中耐药性较低的抗菌药物为替考拉宁、万古霉素,也均为0;经过对症治疗后治愈103例,治愈率79.23%,17例放弃治疗,10例死亡,病死率7.69%。结论脑室-腹腔分流术反复感染以革兰阳性菌为常见病原菌,选择敏感抗菌药物联合手术等治疗后效果显著。

OBJECTIVE To investigate the distribution and drug resistance of the pathogens causing recurrent infec-tions in the patients undergoing ventricle-peritoneal shunt so as to seek the most susceptible antibiotics for symp-tomatic treatment and improve the level of clinical treatment .METHODS A total of 130 patients with recurrent in-fections who underwent the ventricle-peritoneal shunt from Jan 2007 to Jan 2013 were recruited as the study ob-jects ,then the distribution and drug resistance of the pathogens were observed .RESULTS Totally 155 strains of pathogens have been isolated ,of which 34 .19% were the gram-negative bacteria ,52 .26% were the gram-positive bacteria ,and 13 .55% were the fungi .The drug resistance rates of the gram-positive bacteria to imipenem and meropenem were 0 ;the drug resistance rates of the gram-negative bacteria to teicoplanin and vancomycin were 0 . Totally 103 cases were cured after the symptomatic treatment ,with the cure rate of 79 .23% ;17 cases abandoned the treatment ,and 10 cases died ,with the mortality rate of 7 .69% .CONCLUSION The gram-positive bacteria are dominant among the pathogens causing the recurrent infections in the patients undergoing ventricle-peritoneal shunt ,and the use of susceptible antibiotics combined with surgery may achieve significant effect .