抗菌药物治疗颅内感染的研究进展

Advances in the treatment of intracranial infection with antibiotics

神经外科手术患者大脑封闭状态被破坏,易引起继发感染,该术后并发症一直是神经外科难题,严重影响患者愈后及生命安全。随着抗菌药物耐药率的逐年上升和血脑屏障作用,颅内感染治疗问题较难攻克,关键取决于药物是否能透过血脑屏障及脑脊液中的浓度。替加环素、多黏菌素及β-内酰胺类,特别是头孢菌素类和青霉素类,由于其亲水性和耐药性,其在脑脊液中浓度减少,效果不佳,氟喹诺酮类(如莫西沙星、抗结核药物以及利奈唑类药物,在脑脊液中能达到较高的脑脊液/血浆浓度比)已成为新一代治疗颅内感染的首选药物。部分抗菌药物治疗效果不佳的颅内感染,存在颅内真菌感染风险,如伏康唑,两性霉素B,泊沙康唑,卡泊芬净静脉或者脑室给药对预后有积极的作用。对于目前用于治疗中枢神经系统感染的所有药物,可根据给药方案及其时间依赖或浓度依赖的细菌杀灭模式评估药动学/药效学参数为临床治疗提供参考。本文对临床中常用的不同抗菌药物治疗颅内感染进行综述分析。

Patients undergoing neurosurgery often suffer from secondary infection due to the destruction of the closed state of the brain.This postoperative complication has always been a difficult problem in neurosurgery,which seriously affects the recovery and life safety of patients.With the increase of antibiotic resistance rate year by year and the effect of blood-brain barrier,the treatment of intracranial infection is difficult to overcome.The key depends on whether the drug can pass through the blood-brain barrier and the concentration of cerebrospinal fluid.A reduced distribution into CSF has been documented for beta-lactams,especially cephalosporins and penicillins,because of their hydrophilic nature and drug resistance.However,fluoroquinolones,namely moxifloxacin,and anti-tuberculosis drugs,together with the agents such as linezolid,reach the highest CSF/plasma concentration ratio,which have become the preferred drugs of the new generation of anti-intracranial infection.Pharmacokinetic/pharmacodynamic parameters of all drugs currently used for the treatment of CNS infections can be evaluated according to the dosage regimen and its time-dependent or concentration-dependent bactericidal mode to provide reference for clinical treatment.This article reviews the treatment of intracranial infection with different antibiotics.