脑脊液培养的病原菌分布及耐药性分析

Pathogens distribution and drug resistance in cerebrospinal fluid culture

目的:了解脑脊液培养阳性的病原菌分布及药敏情况,为临床经验选用抗生素治疗提供参考。方法:对我院2016年3月~2019年8月送检的脑脊液标本进行培养,采用法国生物梅里埃公司的VITEK-AMS全自动细菌鉴定系统对病原菌进行鉴定和药物敏感性试验。结果:652份脑脊液标本中,分离出病原菌62株,阳性率为9.5%,其中革兰阳性菌24株(38.7%),革兰阴性菌38株(61.3%)。科室分布为神经外科40株(64.5%)、重症监护病房(ICU)9株(14.5%)、儿科8株(12.9%)及其他5株(8.1%)。分离的革兰阴性菌分别为鲍曼不动杆菌、阴沟肠杆菌、铜绿假单胞杆菌。鲍曼不动杆菌对阿米卡星、头孢哌酮/舒巴坦及替加环素的敏感性较高;阴沟肠杆菌对头孢噻利、亚胺培南及复方新诺明敏感;铜绿假单胞杆菌对氨苄西林、氨苄西林/舒巴坦、头孢唑啉、头孢曲松、复方新诺明、呋喃妥因、替加环素耐药性较高。分离的革兰阳性菌主要为凝固酶阴性葡萄球菌,其对替加环素、奎奴普丁/达福普汀、万古霉素、利奈唑胺、呋喃妥因最为敏感。结论:脑脊液培养病原菌以革兰阴性菌为多见,且耐药性也广泛,临床上应依据药敏结果合理选用抗菌药物。

Objective:To explore the pathogens distribution and the drug resistance in the positive results of cerebrospinal fluid(CSF)culture,providing reference for clinical experience antibiotic treatment.Methods:The cerebrospinal fluid samples were isolated and cultured.The identification and antimicrobial susceptibility of pathogens in cerebrospinal fluid were assayed with automatic identification of bacteria by VITEK-AMS system from Bio Mrieux Company.Results:62 strains of pathogenic bacteria were isolated with positive rate of 2.9%among 652 CSF samples,including 24 strains of gram positive bacteria(38.7%)and 38 strains of gram negative bacteria(61.3%).40 strains(64.5%)of the pathogenic bacteria were distributed in the department of neurosurgery,9 strains(14.5%)in intensive care unit(ICU),8 strains(12.9%)in the department of pediatrics and 5 strains(8.1%)in other departments.The gram-negative bacteria isolated from CSF were Acinetobacter baumannii,Enterobacter cloacae,and Pseudomonas aeruginosa,respectively.Acinetobacter baumannii is highly sensitive to amikacin,cefoperazone/sulbactam and tigecycline;Enterobacter cloacae is sensitive to ceftazidime,imipenem,and cotrimoxazole;Pseudomonas aeruginosa to ampicillin,ampicillin/sulbactam,cefazolin,ceftriaxone,cotrimoxazole,nitrofurantoin and tigecycline have higher drug resistance.The gram-positive bacteria isolated from CSF were mainly coagulase-negative Staphylococci,which were most sensitive to tigecycline,quinupristin/dalfopristin,vancomycin,linezolid,and nitrofurantoin.Conclusion:Gram-negative bacteria are the most common pathogens in cerebrospinal fluid cultures with widespread resistance.Therefore,antibacterial drugs should be selectedrationallyin clinical practice.