经鼻蝶入路垂体腺瘤切除术后脑膜炎和/或菌血症的致病菌及抗菌谱分析  

Analysis of pathogens and antibacterial spectrum of meningtis and/or bacteremia after trans-sphenoidal pituitary adenomectomies

作　　者：金雨 刘小海[1] 王瑶[3] 杨启文[3] 连伟[1] 王任直[1] 幸兵[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院神经外科 [2]北京协和医学院 [3]中国医学科学院北京协和医学院北京协和医院检验科,北京100730

出　　处：《基础医学与临床》2017年第11期1611-1614,共4页Basic and Clinical Medicine

基　　金：大学生创新训练计划项目(2017zlgc0605)

摘　　要：目的分析经鼻蝶入路行垂体腺瘤切除术(TSPA)后脑膜炎和/或菌血症的发生率、致病菌、抗菌谱及疗效。方法回顾性分析2012年1月至2016年12月,北京协和医院神经外科TSPA术后经微生物学和临床证实为脑膜炎和/或菌血症的临床及病原学资料。结果 TSPA术后脑膜炎和/或菌血症的发病率为1.2%(59/5 098),27例为脑膜炎,26例为菌血症,6例为脑膜炎合并菌血症。脑脊液培养检出致病菌41株,革兰阳性菌27株(65.9%),最常见为凝固酶阴性葡萄球菌(14株);血培养共检出病原菌34株,革兰阴性菌为主(25株,73.5%),常见为肺炎克雷伯菌(9株)、产气肠杆菌(7株)和大肠埃希菌(5株)。这些致病菌均对阿米卡星、亚胺培南和美罗培南敏感。本组59例经抗生素治疗后治愈52例,死亡7例,其中脑膜炎患者病死率明显高于菌血症患者(21.2%vs 3.1%,P<0.001)。结论 TSPA术后有出现脑膜炎和/或菌血症的可能,两者的常见致病菌、耐药菌比例和预后均不同,应根据药敏结果合理治疗。Objective To evaluate the incidence and microbiology profile of infectious complications（namely meningitis and/or bacteremia） after trans-sphenoidal pituitary adenomectomies（TSPA）.Methods All hospitalized patients undergoing TSPA in Dept.Neurosurgery of Peking Union Medical College Hospital（PUMC） between January2012 and December 2016 were retrospective recorded.Results The incidence of postoperative meningitis and/or bacteremia was 1.2%（59/5 098）.27 cases of meningitis were documented for a total of 41 isolates,26 cases of bacteremia for 34 isolates,and 6 cases of coinfection.Gram-positive organisms predominated（27 cases,65.9%） in meningitis,among which Coagulase-negative staphylococci were the main isolates（14 cases）.The most common organisms causing bacteremia were Gram-negative organisms（25 case,73.5%）,including Klebsiella pneumonia（9 cases）,Enterobacter aerogenes（7 cases） and Escherichia coli（5 cases）,all of which were sensitive to amikacin,imipenem and meropenem.Fifty-two patients were cured after antibiotic treatment,whereas 7 died.Themorality in patients with meningitis was relatively lower than those with bacteremia（21.2% vs 3.1%,P 0.001）.Conclusions Postoperative meningitis and/or bacteremia can occur after TSPA.They differ in etiology profile and prognosis,and should be treated with proper antibiotics according to the drug resistance.

关 键 词：经鼻蝶入路手术 脑膜炎 菌血症 致病菌 

分 类 号：R736.4[医药卫生—肿瘤]