颅脑手术后并发颅内多重/泛耐药鲍曼不动杆菌感染24例治疗总结  

Clinical Effect of 24 Cases in the Treatment of MDR/XDR Acinetobacter Baumannii Intracranial Infection after Posterior Craniotomy

作　　者：夏为[1] 侯云生[1] 卞晓华[2] 

机构地区：[1]解放军白求恩国际和平医院急诊科,石家庄050082 [2]河北医科大学第三医院急诊科,石家庄050000

出　　处：《临床误诊误治》2016年第7期71-74,共4页Clinical Misdiagnosis & Mistherapy

基　　金：河北省2015年度医学科学研究重点课题计划(20150395)

摘　　要：目的探讨颅脑手术后并发颅内多重／泛耐药鲍曼不动杆菌感染的治疗方法。方法收集2012年1月-2015年12月解放军白求恩国际和平医院及河北医科大学第三医院重症监护室收治的，颅脑手术后并发颅内多重／泛耐药鲍曼不动杆菌感染24例的临床资料，观察脑脊液细菌培养、耐药情况及临床疗效、细菌学疗效和28d病死率。结果本组分离的鲍曼不动杆菌对多黏菌素的敏感率为95．8％，对碳青霉烯类药物耐药率极高。24例均给予替加环素50mg（首剂100mg）静脉滴注，每12h1次，连用3～15d；并根据药物敏感试验结果酌情联合应用头孢哌酮钠一舒巴坦钠、美洛培南、哌拉西林钠-他唑巴坦钠及万古霉素。其中14例治疗有效，临床有效率58．3％，细菌清除率54．2％，28d病死率为41．7％。临床疗效及细菌学疗效优者替加环素治疗时间明显延长，28d病死率显著降低，差异均有统计学意义（P〈0．01）。结论替加环素可作为颅脑手术后并发颅内多重／泛耐药鲍曼不动杆菌感染患者的治疗选择，并需根据药物敏感试验结果酌情联用其他抗菌药物治疗。Objective To investigate the clinical characteristics and treatment approaches of multi （MDR） extensively drug-resistant （XDR） Acinetobacter Baumann intracranial infection after posterior craniotomy. Methods Clinical data of 24 patients admitted during January 2012 and December 2015 for Acinetobacter baumannii intracranial infection after intracranial surgery were included. The cerebrospinal fluid culture resistance, clinical efficacy, microbiological eradication rates and mortality rate were evaluated. Results All the 24 cases were treated with tigecycline 50 mg （first dose, 100 rag）, intravenously every 12 h and continuously for 3-15 d. According to the result of drug sensitivity test, cefoperazone sodium sulbactam sodium, meropenem, piperacillin sodium and tazobactam sodium and vancomycin were used in the combination. All the 24 cases were followed up for （29. 1 ±0. 9） days, of which, 14 cases were effective （58.3%） and bacterial clearance rate was 54.2%. There were 10 cases of death and the 28-day overall mortality was 41.7%. Conclusion Tigecycliue might be a therapy option for patients with MDR/XDR Acinetobacter baumannii intracranial infection after posterior craniotomy, and according to the result of drug sensitivity test, other antibacterial drugs can be used in combination.

关 键 词：颅内感染 手术后并发症 鲍氏不动杆菌 替加环素 

分 类 号：R651.1[医药卫生—外科学]