多重耐药鲍曼不动杆菌致颅内感染的治疗及疗效研究

Treatment and efficacy of intracranial infection caused by multidrug-resistant Acinetobacter baumannii

目的研究多重耐药鲍曼不动杆菌致颅内感染的治疗方法及疗效。方法20例多重耐药鲍曼不动杆菌致颅内感染患者,行常规脑室及腰大池引流,采用替加环素联合头孢哌酮/舒巴坦抗感染治疗12~42 d。治疗前后观察患者的临床表现,行腰穿脑脊液检查,检测血C反应蛋白(CRP)、降钙素原(PCT)、S-100b蛋白、肿瘤坏死因子(TNF)-α水平。结果本组患者经抗感染治疗后,痊愈16例、显效4例,脑脊液细胞数、生化指标正常,细菌培养阴性;总有效率100%。治疗1周后的脑脊液白细胞数、多核细胞比、蛋白质含量明显低于治疗前,糖含量高于治疗前;血CRP、PCT、S-100b蛋白、TNF-α水平低于治疗前;差异均有统计学意义(P<0.01~0.001)。患者治疗期间肝肾功能、血尿常规正常,未出现白细胞减少、腹泻、抽搐、过敏等不良反应。停用抗感染治疗2个月后随访复查,患者未发生再次感染。结论多重耐药鲍曼不动杆菌致颅内感染病情重、病死率高,通畅引流,制定合理的治疗方案,选择有效的抗生素,是治疗成功的关键。

Objective To study the treatment and efficacy of intracranial infection caused by multidrugresistant Acinetobacter baumannii.Methods 20 patients with intracranial infection caused by multidrug-resistant Acinetobacter baumannii were treated with conventional intraventricular and lumbar cistern drainage,and tigecycline combined with Cefoperazone/sulbactam for 12-42 days.The clinical manifestations were observed before and after treatment.The cerebrospinal fluid was examined by lumbar puncture.The levels of serum Creactive protein(CRP),procalcitonin(PCT),S-100 B protein and tumor necrosis factor(TNF)-αlevel were detected.Results After anti infection treatment,16 cases were cured and 4 cases were markedly effective.The number of cerebrospinal fluid cells and biochemical indexes were normal,and the bacterial culture was negative;The total effective rate was 100%.The number of white blood cells,the ratio of polynuclear cells and the content of protein in CSF after 1 week of treatment were significantly lower than those before treatment,while the content of sugar was higher than that before treatment;Serum CRP,PCT,S-100B protein,TNF-αThe level was lower than that before treatment;The differences were statistically significant(P<0.01-0.001).During the treatment,the liver and kidney function,blood and urine routine were normal,and there were no adverse reactions such as leucopenia,diarrhea,convulsion,allergy and so on.After stopping anti infective treatment for 2 months,no reinfection occurred.Conclusion The intracranial infection caused by multidrug-resistant Acinetobacter baumannii has a serious condition and high mortality.The key to successful treatment is to make a reasonable treatment plan and choose effective antibiotics.