成人中枢神经系统感染患者脑脊液病原菌特征及预后分析

Characteristics of the pathogens in cerebrospinal fluid and prognosis of the adult patients with central venous system infection

目的研究成人中枢神经系统感染患者脑脊液病原菌特征及患者预后,为该类疾病的临床治疗提供依据。方法回顾性分析2014年1月到2016年9月在四川大学华西医院脑脊液培养阳性的中枢神经系统感染患者的临床特征和实验室检查结果。对患者脑脊液分离病原菌的菌种分布和耐药性进行分析,并对菌种特征与住院患者死亡的关系进行分析。结果共纳入157例病例,包括社区获得性感染87例(55.4%)和医院获得性感染70例(44.6%)。从患者脑脊液标本中共分离出病原菌158株,其中革兰阴性菌73株(46.2%)、真菌64株(40.5%)和革兰阳性菌21株(13.3%)。从菌种分布看,社区获得性感染患者分离菌种以新生隐球菌最多(62/87,71.3%),而医院获得性感染患者以鲍曼/醋酸钙不动杆菌复合体最多(31/71,43.7%)。耐药表型分析结果显示新生隐球菌对抗真菌药物均敏感,鲍曼/醋酸钙不动杆菌复合体对常规治疗药物的耐药率≥90.0%,肺炎克雷伯菌对常规治疗药物的耐药率≤25.0%。革兰阴性菌组、真菌组和革兰阳性菌组的住院死亡率分别为52.3%(38/72)、32.8%(21/64)和19.0%(4/21),三组间差异具有统计学意义(P=0.006),革兰阴性菌组患者死亡率较高。结论我院社区获得性中枢神经系统感染患者脑脊液分离的常见病原菌是新生隐球菌,医院获得性感染患者脑脊液分离常见病原菌是革兰阴性杆菌。革兰阴性菌感染患者死亡率较高。

Objective To investigate the characteristics of the pathogens isolated from the cerebrospinal fluid （CSF） and the prognosis of the adult patients with central venous system （CNS） infection, and to provide the basis for disease treatment. Methods The clinical data and findings of the laboratory examination of the patients, who were admitted to West China Hospital of Sichuan University from January 2014 to September 2016, and suffered from CNS infection with the positive results of CSF culture, were retrospectively analyzed. The species distribution and in-vitro susceptibility of the pathogens and hospital mortality were analyzed. Results A total of 157 cases, involving 87 （55.4%） community-acquired cases and 70 （44.6%） hospital-acquired cases, were included. One hundred and fifty-eight strains of the pathogens were isolated from the CSF specimens of these patients, including 73 isolates （46.2%） of gram negative bacteria, 64 isolates （40.5%） of fungus, and 21 isolates （13.3%） of gram positive bacteria. In terms of species distribution, Cryptococcus neoformans was the predominant （62/87, 71.3%） species isolated from the patient with community-acquired infection, while Acinetobacter calcoaceticus-A, baumannii complex （31/71, 43.7%） was the predominant specie from the patients with hospital-acquired infection. Analysis of the resistance phenotypes showed that all the C. neoformans isolates were susceptible to the antifungal agents. More than 90% ofA. calcoaceticus- A. Baumannii complex isolates were resistant to the regular antibiotics. The resistant rates of K. pneumoniae isolates to the regular antibiotics were no more than 25%. The hospital mortality of the groups infected by gram-negative bacteria, fungi, and gram-positive bacteria were 52.3% （38/72）, 32.8% （21/64）, and 19.0% （4/21）, respectively. There was statistical difference for the hospital mortality among these groups （P=0.006）. Conclusion In our hospital, C neoformans are the common species isolated from CSF of the patients with community-acquired CNS infection. Gram negative bacilli are commonly isolated from CSF of the hospitalacquired cases. The mortality of patients with gram negative bacilli is high.