某院2016年—2017年临床患者脑脊液中致病菌的分布及其耐药性分析

Analysis on Distribution and Resistance of Pathogenic Bacteria in Cerebrospinal Fluid of Clinical Patients in a Hospital during 2016 to 2017

目的:分析临床患者脑脊液(CSF)中常见病原菌的分布及其对抗菌药物的耐药情况,为临床合理选用抗菌药物提供参考。方法:抽取2016年—2017年间医院住院患者脑脊液中常见病原菌培养结果资料,分析其分离出的常见病原菌的分布及其对抗菌药物的耐药性。结果:常见病原菌培养结果中,分离出病原菌菌株95株,标本主要来自神经外科(90.53%)、神经内科(4.21%)和ICU(2.11%);其中革兰阳性菌67株占70.53%,表皮葡萄球菌、溶血葡萄球菌及腐生葡萄球菌位居革兰阳性球菌前3位,分别占18.95%、16.84%和10.53%;革兰阴性菌27株占29.47%,鲍曼不动杆菌为主要分离菌占10.53%、鲍曼/醋酸钙不动杆菌复合体占8.42%、阴沟肠杆菌占3.16%;革兰阳性菌对呋喃妥因、替考拉宁、万古霉素均保持100%完全敏感;呋西地酸除粪肠球菌100%对其耐药外,表皮葡萄球菌等其他球菌对呋西地酸100%敏感;奎奴普丁/达福普汀除粪肠球菌对其100%耐药外,表皮葡萄球菌等均对奎奴普丁/达福普汀100%敏感;鲍曼不动杆菌、鲍曼/醋酸钙不动杆菌复合体、肺炎克雷伯菌肺炎亚种、阴沟肠杆菌、嗜麦芽寡养单胞菌、黏质沙雷菌对阿莫西林-克拉维酸、氨苄西林均高度耐药,而其对多黏菌素高度敏感;哌拉西林除黏质沙雷菌高度敏感外,阴沟肠杆菌对其耐药(66.67%),而对其他菌均高度耐药;第1代头孢唑林除鲍曼/醋酸钙不动杆菌复合体对其高度敏感外,其他均高度耐药;革兰阴性、阳性菌对其他常见药物均呈现不同程度中高度耐药。结论:对患者脑脊液的监测和病原菌的培养和分离,了解其耐药情况和变化原因,以确保预防多重耐药菌的产生和合理用药。

Objective: To analyze the distribution and resistance of pathogenic bacteria in cerebrospinal fluid(CSF) of clinical patients in a hospital during 2016 to 2017, and to provide a reference for the rational selection of antimicrobial agents in clinic. Methods: The data of culture results of common pathogenic bacteria in CSF of hospitalized patients from 2016 to 2017 were extracted to analyze the distribution of isolated common pathogenic bacteria and their resistance to antimicrobial agents. Results: In the culture results of common pathogenic bacteria, 95 strains of pathogenic bacteria were isolated, and the samples were mainly from neurosurgery (90.53%), neurology (4.21%) and ICU (2.11%). Among them, 67 strains of gram-positive bacteria accounted for 70.53%, and Staphylococcus epidermidis, hemolytic Staphylococcus and Saprococcus were the TOP 3 Gram-positive cocci, accounting for 18.95%, 16.84% and 10.53% respectively. Gram-negative bacteria accounted for 29.47% of the 27 strains, while Acinetobacter baumandii was the main isolated bacteria accounting for 10.53%, Baumann-calcium acetate acinetobacter complex accounted for 8.42%, and Enterobacter cloacae accounted for 3.16%. Gram-positive bacteria were 100% sensitive to nitrofurantoin, tikoranin and vancomycin. Except Enterococcus faecalis, other cocci such as Staphylococcus epidermidis were sensitive to furodidi acid. Except Enterococcus faecalis, Staphylococcus epidermidis were all sensitive to quinuptin/dafupretin.Acinetobacter baumannii, Acinetobacter Baumannii/calcium acetate complex, Klebsiella pneumoniae subspecies, Enterobacter cloacae, maltophilia oligomonas and Sarreia were highly resistant to amoxicillin-clavulinic acid and ampicillin but highly sensitive to polycolistin. Except for the highly sensitive slime Sarreia, Enterobacter cloacae was resistant to it (66.67%), while all the other bacteria were highly resistant to it. The first-generation cefazolin was highly resistant to all drugs except Bauman/calcium acetate Acinetobacter complex. Gram-negative and positive bacteria showed high resistance to other common drugs. Conclusion:The CSF of patients and the culture and isolation of pathogenic bacteria should be monitored and the drug resistance and the causes of changes should be understood, so as to ensure the prevention of the emergence of multi-drug resistance bacteria and the rational drug use.