颅内感染患者的脑脊液病原菌分布及常用抗菌药物耐药分析

Distribution of cerebrospinal fluid pathogens in patients with intracranial infections and drug resistance of common antibiotics

目的探讨颅内感染患者脑脊液病原菌分布情况及常用抗菌药物的耐药情况。方法选择医院2013年1月-2016年12月脑脊液病原菌培养阳性的颅内感染患者137例为研究对象;对颅内感染患者脑脊液细菌培养的病原菌结果和药敏试验结果进行分析。结果 137例感染患者共培养病原菌143株,以革兰阳性菌为主,共86株占60.1%;2013年、2014年、2015年、2016年颅内感染患者脑脊液中革兰阳性菌和革兰阴性菌的构成比比较差异有统计学意义(P<0.05);金黄色葡萄球菌对青霉素、红霉素、庆大霉素、环丙沙星的耐药率较高;表皮葡萄球菌对哌拉西林、红霉素、环丙沙星的耐药率较高;肺炎克雷伯菌对头孢曲松、庆大霉素的耐药率较高;鲍氏不动杆菌对头孢曲松、庆大霉素、头孢他啶、磺胺甲噁唑/甲氧苄啶的耐药率较高。结论随着年份增加,颅内感染患者脑脊液中革兰阴性菌比例不断升高,革兰阳性菌以金黄色葡萄球菌和表皮葡萄球菌为主,革兰阴性菌以肺炎克雷伯菌和鲍氏不动杆菌为主,革兰阳性菌和革兰阴性菌对常用抗菌药物的耐药性较高。

OBJECTIVE To investigate the distribution of cerebrospinal fluid pathogens in patients with intracranial infections and drug resistance of common antibiotics.METHODS A total of 137 patients with intracranial infections in the hospital from Jan.2013 to Dec.2016 were enrolled as the study object.The results of bacterial culture and drug sensitivity test in cerebrospinal fluid of patients with intracranial infections were analyzed.RESULTS Totally143 strains of pathogenic bacteria were cultured from 137 cases of infected patients,which were mainly 86 strains of gram-positive bacteria,accounting for 60.1%.There were significant differences in the composition ratio of gram-positive and gram-negative bacteria in cerebrospinal fluid among patients with intracranial infections in2013,2014,2015 and 2016（P〈0.05）.Staphylococcus aureus had high resistant rate to penicillin,erythromycin,gentamicin and ciprofloxacin.The resistant rates of Staphylococcus epidermidis to piperacillin,erythromycin,ciprofloxacin were high,the resistance rates were 83.3%,79.2%,79.2%.The resistant rates of Clostridium pneumoniae to ceftriaxone and gentamicin were high.The resistant rates of Acinetobacter baumannii to ceftriaxone,gentamicin,ceftazidime and cotrimoxazole were high.CONCLUSION With the increase of the year,the proportion of gram-negative bacteria in cerebrospinal fluid in patients with intracranial infection is increasing.The gram-positive bacteria are mainly S.aureus and S.epidermidis,and the gram-negative bacteria were mainly Klebsiella pneumoniae and A.baumannii.The drug resistance rates of gram-positive bacteria and gram-negative bacteria to the commonly used antibacterial are high.