多药耐药及泛耐药鲍氏不动杆菌中枢感染5例诊治分析  

Diagnosis and treatment of CNS infections caused by multidrug-resistant or pandrug-resistant Acinetobacter baumanniiin 5 cases

作　　者：袁利群[1] 兰青[1] 

机构地区：[1]苏州大学第二附属医院,江苏苏州215004

出　　处：《中华医院感染学杂志》2013年第9期2052-2053,共2页Chinese Journal of Nosocomiology

基　　金：江苏省临床医学科技专项资助(BL2012048)

摘　　要：目的探讨脑室或鞘内注射敏感抗菌药物治疗多药耐药及泛耐药鲍氏不动杆菌中枢感染的疗效,为临床合理用药提供参考。方法对5例鲍氏不动杆菌中枢感染病例严格按照脑脊液培养及药敏结果选择敏感抗菌药物,通过静脉联合脑室或鞘内给药;结合脑脊液细菌学结果及患者原发疾病选择抗菌药物及给药途径,同时监测患者感染相关指标及头颅CT、MRI等影像学检查;对感染并发脑积水通过脑室外或腰大池引流进行处理。结果治疗后5例患者中3例脑脊液培养阴性,其中2例治愈,1例因家属放弃治疗带脑积水出院;2例仅多黏菌素敏感患者死亡。结论早期脑室及鞘内注射敏感抗菌药物是治疗多药耐药鲍氏不动杆菌中枢感染的安全有效方法;脑积水发生率较高,脑室外引流优于腰大池引流,引流需早期进行并保持通畅。OBJECTIVE To explore the effectiveness of injecting sensitive antibiotics intraventricularly or intrathecally in treatment of CNS infections caused by multidrug-resistant or pandrug-resistant Acinetobacter baumannii so as to guide the clinical treatment.METHODS Totally five cases with CNS infections caused by multidrug or pandrug-resistant A.baumannii were retrospectively analyzed.During the clinical cause,the antibiotics were strictly chosen according to cerebral spinal fluid cultures and drug susceptibility testing.Antibiotics were applied intravenously and intraventricularly or intrathecally.The infection related parameters were monitored;CT and MRI scan were followed up.Complicated hydrocephalous was treated through ventricular cistern drainage or lumber cistern drainage.RESULTS After the treatment,three in five cases were with the CSF cultured negative,tuo cases cured,and one discharged with untreated hydrocephalous due to the family’s giving up the treatment.The rest two cases died because of unavailable of colistin which was the only sensitive antibiotic.CONCLUSION Early injection of sensitive antibiotics intraventricularly or intrathecally is an effective way to treat CNS infections caused by multidrug-resistant A.baumannii.The incidence of hydrocephalous is high.The ventricular cistern drainage is better than lumber cistern drainage,and drainage should be performed early and kept unobtrusive.

关 键 词：鲍氏不动杆菌 多药耐药 中枢感染 

分 类 号：R181.32[医药卫生—流行病学]