开颅患者颅内鲍氏不动杆菌感染的临床研究

Clinical study on Acinetobaeter baumannii infections after craniotomy

目的观察与分析开颅患者术后颅内感染鲍氏不动杆菌(ABA)的耐药性及临床治疗方法,为合理制定治疗方案提供参考依据。方法选取2012年1月-2014年12月术后颅内ABA感染患者50例,给予美罗培南静脉滴注联合鞘内注射及腰大池穿刺置管持续引流治疗,对患者脑脊液标本中培养分离出的ABA耐药性、治疗前后脑脊液中的白细胞计数、蛋白质、葡萄糖水平及临床疗效进行观察和比较。结果术后颅内感染患者脑脊液中检出50株ABA,其对头孢噻吩、头孢西丁、头孢呋辛的耐药率均较高,分别为100.0%、98.0%和96.0%,而对美罗培南、亚胺培南、头孢吡肟的耐药率较低,分别为54.0%、56.0%和60.0%;颅内ABA感染患者的脑脊液中白细胞计数、蛋白质较治疗前显著下降,葡萄糖水平较治疗前显著上升(P<0.05),临床治疗有效率为94.0%。结论开颅患者术后颅内感染ABA的耐药性较高,应用美罗培南静脉滴注联合鞘内注射及腰大池穿刺置管持续引流治疗具有较好的临床疗效。

OBJECTIVE To observe and analyze the drug resistance of Acinetobaeter baumannii （ABA）, which caused infections in patients after craniotomy so as to provide an objective basis for rational formulation of treat- ment. METHODS Totally 50 cases of patients with postoperative intracranial ABA infections from Jan. 2012 to Dec. 2014 were selected and treated with meropenem infusion combined with intrathecal injection and lumbar puncture indwelling tube continuous drainage. The drug resistances of ABA strains isolated from the cerebrospinal fluid, the leukocyte count and the protein, glucose levels irt the cerebrospinal fluid before and after the treatment and the clinical efficiency of the patients were observed and compared. RESULTS The 50 ABA strains in the cere- brospinal fluid of the patients with postoperative intracranial ABA infections were relatively resistant to cefoxitin, ceftazidime, and cefuroxime, and the resistance rates were 100.0%, 98. 0% and 96.0% relatively. However, they were more sensitive to meropenem, imipenem, and cefepime with the resistance rates of 54.0%, 56.0% and 60.0%. The leukocyte count and the protein level in the cerebrospinal fluid of the patients with postoperative in- tracranial ABA infections after the treatment decreased and the glucose level increased significantly compared with those before the treatment （P〈0.05）. The clinical efficiency was 94.0%. CONCLUSION The drug resistance of the pathogens in patients with postoperative intracranial ABA infections is higher. The application of meropenem infusion combined with intrathecal injection and lumbar puncture indwelling tube continuous drainage can achieve better therapeutic effects in the treatment of such infection.