脑室-腹腔分流术后颅内感染的病原学分析及抗菌药物优化治疗  

Etiological analysis of intracranial infections after ventricle-peritoneal shunt and optimized antibiotics therapy

作　　者：陈大刚[1] 张艳蕉[1] 赵静[2] 

机构地区：[1]齐齐哈尔医学院附属第三医院神经外科,黑龙江齐齐哈尔161000 [2]齐齐哈尔医学院附属第三医院血液透析室,黑龙江齐齐哈尔161000

出　　处：《中华医院感染学杂志》2014年第3期605-606,609,共3页Chinese Journal of Nosocomiology

基　　金：黑龙江省卫生厅基金资助项目(HW-2010B-011)

摘　　要：目的分析脑室-腹腔分流术后颅内感染的病原学及对抗菌药物的优化治疗,为临床诊断治疗提供依据。方法选择2012年10月-2013年10月进行脑室-腹腔分流术后颅内感染患者71例,对其病原菌进行分离鉴定及药敏试验,并进行病原学分析及抗菌药物的优化治疗,采用SPSS17.0软件进行数据统计分析。结果 71例颅内感染患者送检标本共分离出病原菌94株,其中革兰阳性菌63株占67.02%、革兰阴性菌27株占28.72%、真菌4株占4.26%;大肠埃希菌对阿莫西林/舒巴坦以及头孢曲松的耐药率最高,均为44.44%,对哌拉西林/他唑巴坦以及美罗培南的耐药率最低,均为11.11%;金黄色葡萄球菌、表皮葡萄球菌对青霉素的耐药率分别为90.00%、44.44%,对万古霉素的耐药率均为0;71例患者中29例颅内感染得到控制,脑脊液细菌培养阴性,体温降至正常。结论脑室-腹腔分流术后颅内感染以革兰阳性菌多见,治疗应按照药敏试验结果进行抗菌药物优化治疗,做到早发现、早治疗,改善患者预后。OBJECTIVE To analyze the etiology of intracranial infections after ventricle-peritoneal shunt and observe the optimized antibiotics therapy so as to provide guidance for clinical diagnosis and treatment. METHODS A total of 71 cases of intracranial infections, who underwent the ventricle-peritoneal shunt from Oct 2012 to Oct 2013, were enrolled in the study, then the isolation, identification, and drug susceptibility testing of pathogens were performed, the etiological analysis and the optimized drug therapy were conducted, and the statistical analysis was performed with the use of SPSS17.0 software. RESULTS A total of 94 strains of pathogens have been isolated from submitted specimens from the 71 cases of intracranial infections , including 63 （67.02%） strains of gram-positive bacteria, 27 （28. 72%） strains of gram-negative bacteria, and 4 （4.26%） strains of fungi. The drug resistance rate of the Escherichia coli to mezlocillin-sulbactam was the highest （44.44%）, while the drug resistance rates to piperacillin-sulbactam and meropenem were the lowest （11.110% ） ; the drug resistance rates of the Staphylococcus aureus and Staphylococcus epidermidis to penicillin were 90. 00% and 44. 44%, respectively, and the drug resistance rates to vancomycin were 0. The intracranial infections in 29 of 71 patients have been controlled, the cerebrospinal fluid was cultured negative, and the body temperature dropped to the normal. CONCLUSION The gram-positive bacteria are common pathogens causing intracranial infections after ventricle-peritoneal shunt; it is necessary to perform the optimized drug therapy according to the result of drug susceptibility testing so as to achieve early detection and treatment and improve outcomes of the patients.

关 键 词：脑室-腹腔分流术 颅内感染 病原菌 分布 抗菌药物 

分 类 号：R378[医药卫生—病原生物学]