477例中枢神经系统感染脑脊液培养阳性患者的临床特征及病原菌耐药性分析

Clinical characteristics and drug resistance analysis of 477 cases of central nervous system infection with positive cerebrospinal fluid culture

目的 分析477例中枢神经系统感染脑脊液培养阳性患者的临床特征及耐药性,为临床合理用药提供依据。方法 收集2019年1月—2020年12月南京医科大学附属儿童医院儿童患者与南京医科大学附属脑科医院成人患者脑脊液标本数据,对分离的病原菌种类及耐药性进行回顾性分析。结果 从收集的4 149份脑脊液标本中,共分离病原菌477株,阳性率11.49%,神经外科送检阳性率(12.62%)最高;成人组患者脑脊液培养阳性检出率较高,儿童组患者检出阳性率较低;72.3%的患者有临床发热症状,90.5%的患者有基础疾病;药敏试验结果显示,耐甲氧西林凝固酶阴性葡萄球菌、耐甲氧西林金黄色葡萄球菌与对应的敏感菌相比耐药性较高;鲍曼不动杆菌对亚胺培南、美罗培南的耐药率分别为73.2%和70.7%,高于其他革兰阴性菌。结论 脑脊液培养及相关实验室指标对中枢神经系统感染诊断及治疗具有重要临床意义。

Objective To analyze the clinical characteristics and drug resistance of 477 cases of central nervous system infection with positive cerebrospinal fluid culture,and to provide evidence for rational drug use in clinic.Methods From January 2019 to December 2020,the data of cerebrospinal fluid samples from pediatric patients in Children’s Hospital of Nanjing Medical University and adult patients in the Affiliated Brain Hospital of Nanjing Medical University were collected,and the types and drug resistance of the isolated pathogens were retrospectively analyzed.Results A total of 477 strains of pathogens were isolated from 4 149 cerebrospinal fluid samples,with a positive rate of 11.49%,and the highest positive rate(12.62%) in the department of neurosurgery.The positive rate of cerebrospinal fluid culture in the adult group was higher,and the positive rate in the children group was lower.72.3% patients had clinical fever symptoms,and 90.5% patients had underlying diseases.Drug susceptibility test results showed that methicillin-resistant coagulase-negative Staphylococci and methicillin-resistant Staphylococcus aureus had higher drug resistance than the corresponding sensitive bacteria;the resistance rates of Acinetobacter mansibacter to imipenem and meropenem were 73.2% and 70.7%,respectively,which were higher than those of other gram-negative bacteria.Conclusion Cerebrospinal fluid culture and related laboratory indicators have important clinical significance for the diagnosis and treatment of central nervous system infection.