老年颅脑损伤中枢神经系统感染患者脑脊液病原菌分布与药敏变迁分析

Distribution and drug susceptibility of pathogens isolated from cerebrospinal fluid of elderly craniocerebral injury patients with central nervous system infections

目的探讨老年颅脑损伤中枢神经系统感染患者脑脊液病原菌分布及对抗菌药物敏感性的变迁,为全程选择抗菌药物治疗提供依据。方法选取2011-2013年老年颅脑损伤中枢神经系统感染患者308例,其中2011年106例、2012年98例、2013年104例,对其检出的病原菌分布及药物敏感性进行统计和分析。结果 2011、2012、2013年颅脑损伤中枢神经系统患者感染率分别为1.33%、1.28%、1.26%;2011、2012、2013年检出病原菌分别为103株、95株和101株,阳性检出率分别为97.17%、96.94%和97.12%,培养阳性率差异无统计学意义;3年革兰阳性菌检出分别占73.79%、71.58%和65.35%,呈逐年减少的趋势,差异有统计学意义(P<0.05),而真菌感染率3年分别占5.83%、6.32%和7.92%,呈逐年升高的趋势;3年革兰阳性菌和革兰阴性菌对抗菌药物的敏感性无明显改变,总体呈现出逐年降低的趋势。结论 3年导致老年颅脑损伤患者中枢神经系统感染的病原菌分布有明显的改变,而病原菌对抗菌药物的敏感性呈现出下降趋势,替考拉宁、万古霉素以及亚胺培南仍然是目前较为理想的经验性用药选择。

OBJECTIVE To investigate the distribution and drug susceptibility of the pathogens isolated from the cerebrospinal fluid of the elderly craniocerebral injury patients with central nervous system infections so as to provide guidance for the whole-process drug therapy.METHODS A total of 308 elderly craniocerebral injury patients with central nervous system infections who were treated in the hospital from 2011 to 2013were enrolled in the study,including 106 cases in 2011,98 cases in 2012,and 104 cases in 2013.The distribution and drug susceptibility of the isolated pathogens were statistically analyzed.RESULTS The incidence of central nervous system infections in the patients with craniocerebral injury was 1.33% in 2011,1.28% in 2012,and 1.26% in 2013.Totally 103（97.17%）strains of pathogens were isolated in 2011,95（96.94%）strains in 2012,and 101（97.12%）strains in2013,with no significant difference in the positive rate of culture.The isolation rate of the gram-positive bacteria was 73.79%in 2011,71.58%in 2012,and 65.35%in 2013,showing a downward trend,and the difference was statistically significant（P〈0.05）.The incidence of fungal infections was 5.83%in 2011,6.32%in 2012,and7.92%in 2013,showing an upward trend.The drug susceptibility of the gram-positive bacteria and gram-negative bacteria did not change remarkably in the three years and showed a downward trend.CONCLUSION The distribution of the pathogens causing the central nervous system infections in the elderly patients with craniocerebral injury does not change significantly in the three years,however,the drug susceptibility of the pathogens shows a downward trend.At present,teicoplanin,vancomycin,and imipenem remain the ideal drugs for empirical medication.