脑脊液耳漏患者肺炎克雷白杆菌感染的临床分析

Clinical analysis of Klebsiella pneumoniae infection in patients with cerebrospinal fluid otorrhea

目的 分析脑脊液耳漏患者肺炎克雷白杆菌感染的临床表现、危险因素及治疗措施.方法 采集脑脊液耳漏患者24例,对脑脊液培养证实肺炎克雷白杆菌生长患者的资料进行统计学分析.结果 本组患者共24例,男16例,女8例;年龄20-71（37.5±15.4）岁;单侧耳漏患者感染3例,双侧耳漏患者感染9例,开颅手术合并耳漏患者感染11例,耳漏合并鼻漏感染3例,其感染率分别为0.19％、0.64％、1.56％、0.35％;开颅手术组与单纯耳漏组比较差异有统计学意义（P〈0.05）;开放性脑损伤手术感染率为0.81％,未手术感染率为0.27％,差异有统计学意义（P〈0.05）;预防性用药者感染率为0.30％,未预防性用药者为0.61％,差异未见统计学意义（P〉0.05）.肺炎克雷白杆菌总体检出率为66.7％,2013年前为50.0％,2015年后为90％.亚胺培南敏感率为100％.结论 肺炎克雷白杆菌感染多发生在开放性脑损伤合并脑脊液耳漏患者,预防性用药不能降低其感染率.肺炎克雷白杆菌检出率逐年增高,但其对亚胺培南均敏感.

Objective To analyze the clinical manifestations,risk factors and treatment meas-ures of Klebsiella pneumoniae infection in patients with cerebrospinal fluid leakage. Methods Twenty-four cases of cerebrospinal fluid leakage were collected,and the data of CSF culture confirmed Klebsiella pneumoniae growth were statistically analyzed. Results Among the 24 patients,male 16 cases,female 8 cases;age 20 - 71（37. 5 ± 15. 4）years old;3 cases were infected by unilateral ear leakage;9 cases suf-fered from bilateral ear leakage;11 cases of craniotomy combined with ear leakage were infected;3 cases of Otorrhea with rhinorrhea were infection. The infection rate was 0. 19%,0. 64%,1. 56% and 0. 35%,there was a significant difference between craniotomy group and simple ear omission group （P 〈0. 05）;the infection rate of open brain injury was 0. 81%,the infection rate was 0. 27% in ono poerative patients,the difference was significant （P 〈0. 05）;the infection rate of prophylaxis was 0. 30%,preventive medication was 0. 61%,the difference was not significant （P 〉0. 05）. The overall detection rate of Klebsiella pneumoniae was 66. 7%,before 2013 was 50%,after 2015 was 90%. The sensitivity rate of imipenem was 100%. Conclusions Klebsiella pneumoniae infection is common in patients with open brain injury complicat-ed with cerebrospinal fluid otorrhea,preventive drug use can not reduce the rate of infection. The detection rate of Klebsiella pneumoniae increases year by year,but they are sensitive to imipenem.