神经外科术后患者脑脊液中肠杆菌科和不动杆菌属细菌主动监测及防控

Active monitoring of Enterobacteriaceae and Acinetobacter sppisolated from cerebrospinal fluid of neurosurgery department patients after surgery and prevention measures

目的主动监测神经外科术后患者脑脊液中肠杆菌科和不动杆菌属细菌感染的菌群分布及耐药性变化。方法选取2015年1月-2017年12月某三甲医院神经外科术后患者作为研究对象,由感染控制专职人员及神经外科主管医生进行前瞻性主动监测,对脑脊液中肠杆菌科和不动杆菌属菌株分布和感染菌株的耐药性情况进行分析,提出干预对策。结果本研究共送检脑脊液样本3784份,共分离出细菌674株,检出率为17.81%,其中肠杆菌科细菌53株占7.86%,不动杆菌属细菌74株占10.98%;肠杆菌科细菌中大肠埃希菌18株占33.96%,其次依次为肺炎克雷伯菌、产酸克雷伯氏菌、阴沟肠杆菌等,不动杆菌属中鲍氏不动杆菌53株占71.62%,其次是洛菲不动杆菌和鲁氏不动杆菌;脑脊液中培养分离得到鲍氏不动杆菌对阿莫西林/克拉维酸及氨曲南全部耐药,对美罗培南和亚胺培南中度敏感,未检出多粘菌素B及替加环素耐药菌株。结论加强神经外科手术后患者细菌耐药性的主动监测,及时了解神经外科脑脊液中常见病原菌的流行病学与耐药现状变化,对优化抗菌药物使用、制定有效的医院感染防控措施,降低感染发生率具有重要作用。

OBJECTIVE To actively monitor the distribution and drug resistance of Enterobacteriaceae and Acinetobacter sppstrains isolated from cerebrospinal fluid of the neurosurgery department patients with infections after surgery.METHODS The patients who underwent surgical procedures in neurosurgery department of a three-A hospital from Jan 2015 to Dec 2017 were recruited as the study objects,the prospective active monitoring was carried out by full-time infection control personnel and neurosurgery department doctors in charge,the distribution and drug resistance of the Enterobacteriaceae and Acinetobacter sppstrains isolated from the cerebrospinal fluid were observed,and the intervention countermeasures were proposed.RESULTS A total of 674 strains of bacteria were isolated from 3784 submitted cerebrospinal fluid specimens,with the isolation rate 17.81%,53（7.86%）of which were Enterobacteriaceae,and 74（10.98%）were Acinetobacter spp.Among the Enterobacteriaceae strains,Escherichia coli（18 strains,33.96%）strains were dominant,followed by Klebsiella pneumoniae,Klebsiella oxytoca and Enterobacter cloacae.Among the Acinetobacter sppstrains,Acinetobacter baumannii strains（53 strains,71.62%）were dominant,followed by Acinetobacter lwoffii and Acinetobacter rofeci.Al of the A.baumannii strains isolated from the cerebrospinal fluid specimens were resistant amoxicillin-clavulanic acid and aztreonam and showed medium sensitivity to meropenem and imipenem,and no strains resistant to polymyxin B or tigecycline were isolated.CONCLUSIONIt is important for optimization of use of antibiotics,development of effective prevention measures and reduction of incidence of infection to strengthen the active monitoring of the bacterial drug resistance of the neurosurgery departments after the surgery and comprehensively understand the epidemiological characteristics and drug resistance of common species of pathogens isolated from the cerebrospinal fluid specimens.