神经外科患者术后颅内感染病原菌特点与耐药性分析

Characteristics and drug resistance analysis of pathogens of postoperative intracranial infections in neurosurgical patients

目的探讨神经外科患者术后颅内感染脑脊液病原菌特点及耐药性,为临床医师的合理用药提供参考。方法采集2011年6月-2013年6月90例颅内感染患者的脑脊液标本,采用Microscan Wallk Away-40全自动细菌鉴定仪及药敏分析系统进行细菌培养及药敏试验,数据采用SPSS 16.0软件进行统计分析。结果 90例患者送检脑脊液标本共106份,细菌培养阳性54份,阳性率为50.94%;分离出病原菌71株,以革兰阳性菌为主,共41株占57.75%;凝固酶阴性葡萄球菌、金黄色葡萄球菌对青霉素、氨苄西林、左氧氟沙星耐药率均>80.00%,对哌拉西林/他唑巴坦、万古霉素完全敏感;鲍氏不动杆菌、铜绿假单胞菌对哌拉西林、头孢他啶、头孢吡肟、头孢曲松、头孢哌酮、氨曲南、亚胺培南、阿米卡星耐药率均>50.00%,对哌拉西林/他唑巴坦、美罗培南相对耐药性均<50.00%。结论神经外科术后颅内感染患者脑脊液细菌培养显示,感染病原菌以革兰阳性菌为主,感染病原菌对临床多种抗菌药物耐药率较高。

OBJECTIVE To explore the characteristics and drug resistance of pathogens of postoperative intracranial infections in neurosurgical patients so as to provide references for clinical rational drug use .METHODS Cerebro‐spinal fluid specimens were collected from 90 cases of patients with clinical diagnosis of intracranial infections dur‐ing Jun .2011 to Jun .2013 .The Microscan Wallk Away‐40 full‐auto bacterial identifier was used for bacterial cul‐ture and drug susceptibility test .The software SPSS16 .0 was used for statistical analysis of data .RESULTS A to‐tal of 106 cerebrospinal fluid specimens from 90 patients were inspected ,the bacterial culture results of cerebrospi‐nal fluid were positive for 54 cases ,with the positive rate of 50 .94% .Totally 71 strains of pathogenic bacteria were isolated ,mainly including 41 strains of gram‐positive bacteria ,accounting for 57 .75% .Coagulase‐negative Staphylococcus and Staphylococcus aureus had resistance 〉80 .00% to penicillin ,ampicillin ,and levofloxacin and they were completely sensitive to piperacillin/tazobactam and vancomycin .Acinetobacter baumannii and Pseudo‐monas aeruginosa had the resistant rate 〉50 .00 to piperacillin ,ceftazidime ,cefepime ,ceftriaxone ,cefoperazone , aztreonam ,imipenem ,and amikacin ,and their relative resistance was 〈50 .00% to piperacillin/tazobactam and meropenem .CONCLUSION Cerebrospinal fluid bacterial culture for neurosurgical patients with postoperative in‐tracranial infection shows that pathogenic bacteria are mainly gram‐positive bacteria ,and the infectious pathogens are highly resistant to a variety of clinical antimicrobial drugs .