替加环素鞘内注射治疗多重耐药鲍曼不动杆菌颅内感染

Tigecycline intrathecally administration on intracranial infection of multiple drug resistant Acinetobacter Baumannii

目的探讨替加环素治疗多重耐药鲍曼不动杆菌(MDRAB)颅内感染的临床经验。方法分析中国人民解放军总医院第四医学中心神经外科2014年10月1日—2016年8月1日收治的6例MDRAB颅内感染患者的临床资料。记录患者脑脊液(CSF)的性状,细菌学及药敏试验结果。所有患者均根据CSF检验结果在常规治疗的基础上,给予替加环素50 mg(首次100 mg)静脉注射,1次/12 h;并以浓度为0.5 mg/mL的替加环素10 mL缓慢鞘内注射,1次/d,疗程9~21 d,平均14 d;观察临床疗效。结果6例MDRAB感染患者颅内感染均有效控制,未出现感染相关的神经功能障碍。随访1年,患者无感染复发。结论临床上替加环素的耐药率低,对MDRAB敏感性较高,但其血-脑屏障通过率低。颅内感染MDRAB后采用替加环素静脉滴注,并且同期行鞘内注射治疗,效果明显,临床未出现药物相关的神经功能障碍。

Objective To explore the administration of tigecycline for intracranial infection of multiple drug resistant Acinetobacter Baumannii(MDRAB).Methods The clinical data of 6 patients with intracranial MDRAB infection admitted in Department of Neurosurgery,The Fourth Cilnical Center,PLA General Hospital from October 1st 2014 to August 1st 2016 were analyzed retrospectively.The results of the appearance,bacteria and drug sensitive test of cerebral spinal fluid(CSF)of these patients were extracted.Based on these results,tigecycline was administered 50 mg 1/12 h intravenously(100 mg for the first administration)companying with some basic treatment.Another 10 mL tigecycline with the concentration of 0.5 mg/mL was administered 1/12 h intrathecally.The therapeutic period was 9-21 days and the average duration was 14 days.The results of the therapy were observed.Results 6 cases of intracranial MDRAB infection were cured after treatment.No significant nervous function disorders were observed.The follow-up period was 1 year.During this period,no infection recurrence was observed in these patients.Conclusions The drug resistant rate of tigecycline is low in the clinical practice and tigecycline is more sensitive to MDRAB.But tigecycline is hard to pass through the blood brain barrier.When intracranial MDRAB infection occurred,the effectiveness of tigecycline was not satisfactory for simply venous administration in some cases.Simultaneously intrathecally administration of tigecycline has better effectiveness,and the nervous function disorders due to the drug are minimal.