颅内动脉瘤术后中枢神经系统感染患者脑脊液病原菌分布 药敏试验及耐药基因分析

Analysis of distribution,drug sensitivity test and drug resistance genes of cerebrospinal fluid pathogenic bacteria in patients with central nervous system infection after intracranial aneurysm

目的 分析颅内动脉瘤(IA)介入手术后中枢神经系统(CNS)感染患者脑脊液病原菌分布、耐药性及抗菌治疗。方法 选取2020-03—2022-03新乡医学院第三附属医院的IA介入术后CNS感染患者64例为研究对象,采集脑脊液进行培养分离和药敏试验,检测其中主要病原菌耐药基因,并分析其与耐药性的关系。结果 64例CNS感染患者中58例脑脊液培养结果为阳性,占90.63%,共分离出病原菌58株,其中革兰阳性菌35株(60.34%),以金黄色葡萄球菌为主(20株,34.48%),革兰阴性菌23株(39.66%)。药敏试验显示,革兰阳性菌中青霉素G、克林霉素、红霉素、苯唑西林和头孢西丁耐药率较高,万古霉素、呋喃妥因、左氧氟沙星和利奈唑胺耐药率较低;革兰阴性菌中阿莫西林、头孢类抗生素、氨曲南和庆大霉素耐药率较高,环丙沙星、美罗培南和亚胺培南耐药率较低。20株金黄色葡萄球菌中ermA、ermB、ermC、msrA、msrB、aac(6')/aph(2'')、mecA、femB和gyrA检出率分别为30.00%、10.00%、45.00%、40.00%、20.00%、30.00%、55.00%、45.00%和20.00%,与耐药性进行对应分析显示mecA/femB与青霉素G符合率为75.00%,与苯唑西林符合率为85.00%;erm/msr与克林霉素符合率为70.00%,与红霉素符合率为90.00%;aac(6')/aph(2'')与庆大霉素符合率为90.00%;gyrA与左氧氟沙星符合率为85.00%,与环丙沙星符合率为75.00%;mecA与头孢西丁符合率为80.00%。结论 IA术后CNS感染病原菌以革兰阳性菌更为常见,且细菌耐药率较高,明确耐药性及相应基因型可为合理选用抗菌药物提供参考依据,从而提升抗感染治疗效果。

Objective To analyze the distribution,drug resistance and antibacterial treatment of cerebrospi-nal fluid pathogenic bacteria in patients with central nervous system(CNS)infection after intracranial aneurysm(IA)interventional therapy.Methods From March 2020 to March 2022,64 patients with CNS infection after IA in-terventional therapy in the Third Affiliated Hospital of Xinxiang Medical University were selected as the study sub-jects.Cerebrospinal fluid was collected for culture isolation and drug sensitivity test,and the drug resistance genes of main pathogenic bacteria were detected and their relationship with drug resistance was analyzed.Results Among the 64 patients with CNS infection,there were 58 cases with positive cerebrospinal fluid culture results,accounting D0I:10.12083/SYSJ.230570 for 90.63%.A total of 58 strains of pathogenic bacteria were isolated,including 35 strains(60.34%)of Gram-positive bacteria(mainly Staphylococcus aureus)20 strains(34.48%)and 23 strains(39.66%)of Gram-negative bacteria.Drug sensitivity results showed that among Gram-positive bacteria,the resistance rates of penicillin G,clindamycin,erythromycin,oxacillin and cefoxitin were higher while the resistance rates of vancomycin,nitrofurantoin,levofloxacin and linezolid were lower.Among Gram-negative bacteria,the resistance rates of amoxicillin,cephalosporins,aztreo-nam,and gentamicin were higher while the resistance rates of ciprofloxacin,meropenem,and imipenem were lower.The detection rates of 20 strains of Staphylococcus aureus such as ermA,ermB,ermC,msrA,msrB,aac(6′)/aph(2″),mecA,femB and gyrA were 30.00%,10.00%,45.00%,40.00%,20.00%,30.00%,55.00%,45.00%and 20.00%,re-spectively.Corresponding analysis with drug resistance showed that the coincidence rate of mecA/femB was 75.00%with penicillin G and was 85.00%with oxacillin,and the coincidence rate of erm/msr was 70.00%with clindamycin and was 90.00%with erythromycin,and the coincidence rate of aac(6′)/aph(2″)was 90.00%with gentamicin,and the coincidence rate of gyrA was 85.00%with levofloxacin and was 75.00%with ciprofloxacin,and the coincidence rate of mecA with cefoxitin was 80.00%.Conclusion Gram-positive bacteria are more common pathogenic bacteria of CNS infection after IA,and the bacterial resistance rates are higher.The identification of drug resistance and corre-sponding genotypes can provide a reference for the rational selection of antibacterial drugs,thereby improving the anti-infective treatment effect.