颅脑手术后多重耐药革兰阴性菌脑室炎的治疗  

Treatment of craniocerebral postoperative patients with ventriculitis caused by multi-drug resistant gram-negative bacteria

作　　者：周强[1] 胡锦 王之敏[1] 徐云峰[1] ZHOU Qiang;HU Jin;WANG Zhi-min(Department of Neurosurgery, Suzhou Jiulong Hospital Affiliated to Medical School of Shanghai Jiaotong University, Suzhou 215028, China)

机构地区：[1]上海交通大学医学院附属苏州九龙医院神经外科,苏州215028 [2]复旦大学附属华山医院神经外科

出　　处：《临床神经外科杂志》2020年第6期714-716,720,共4页Journal of Clinical Neurosurgery

基　　金：苏州工业园区培育科技项目(JL201705)。

摘　　要：目的探讨颅脑术后多重耐药革兰阴性菌脑室炎的治疗方法及其效果。方法回顾性分析5例颅脑术后多重耐药革兰阴性菌脑室炎患者的病例资料。其中2例患者脑脊液培养为多重耐药鲍曼不动杆菌,3例患者为碳青霉烯类耐药肺炎克雷伯菌感染。所有患者均行Ommaya囊置入术+侧脑室外引流术,并予以抗生素脑室灌洗,同时针对细菌药敏结果使用相应的抗生素静脉注射治疗。术后随访3~6个月,观察评价治疗效果。结果2例肺炎克雷伯菌脑室炎患者治疗无效死亡,3例脑室炎(2例MDR-Ab,1例CRKP感染)患者达到临床治愈。结论多重耐药革兰阴性菌脑室炎是颅脑术后非常严重的并发症。及时行Ommaya囊置入术+侧脑室外引流术,同时给予抗生素脑室内灌洗,结合抗生素静脉注射治疗,能够提高多重耐药革兰阴性菌脑室炎的治愈率。Objective To explore the treatment of multidrug-resistant Gram-negative ventriculitis after craniocerebral surgery.Methods The clinical data of 5 patients of multidrug-resistant Gram-negative bacteria ventriculitis after craniocerebral surgery were retrospectively analyzed.3 patients were infected after craniocerebral trauma surgery,1 was after removal of spontaneous cerebral hematoma,and 1 was after resection of the right cavernous sinus tumor.Cerebrospinal fluid culture results showed that 2 patients had multi-drug-resistant acinetobacter baumannii and 3 had carbapenem-resistant Klebsiella pneumonia.All patients underwent Ommaya sac placement+lateral ventricular drainage and intraventricular lavage.At the same time,corresponding antibiotics were used according to bacterial drug sensitivity results.After 3-6 months,all patients were followed up to evaluate the treatment effect.Results 2 patients with carbapenem-resistant pneumonia Klebsiella ventricularitis died during the course of the treatment,3 patients were cured clinically.Conclusions Multi-drug resistant Gram-negative bacteria ventriculitis after craniocerebral surgery is a very serious complication.The cure rate of ventriculitis can be improved by timely placement of Ommaya capsule and lateral ventricular drainage,and intraventricular irrigation with antibiotics.

关 键 词：颅内感染 多重耐药 鲍曼不动杆菌 肺炎克雷伯菌 头孢他啶阿维巴坦 

分 类 号：R651[医药卫生—外科学]