脑脓肿的临床、微生物学特征及其预后相关因素分析  

The clinical and microbiological characteristics and prognostic factors of brain abscesses

作　　者：黄娜[1,2] 周翠 曹建明[3] 陈丽琼[3] 刘世星[1] 廖文丽 周铁丽 叶建中[1] Huang Na

机构地区：[1]温州医科大学附属第一医院,325035 [2]重庆大学附属三峡医院,404000 [3]温州医科大学,325035

出　　处：《浙江临床医学》2023年第2期190-192,共3页Zhejiang Clinical Medical Journal

基　　金：国家白然科学基金资助项目(82072347);浙江省检验诊断及转化研究重点实验室资助项目(2022E10022)。

摘　　要：目的 分析脑脓肿的临床、微生物学特征及其预后相关因素.方法 回顾性分析2012年1月至2019年12月温州医科大学附属第一医院脑脓肿患者的临床资料,采用MALDI-TOF-MS微生物鉴定系统和VITEK 2 Compact全自动微生物分析系统对脑脓肿患者各类送检标本中培养出的病原菌进行鉴定和药敏试验,并通过分析比较脑脓肿患者的临床结局以发现其预后不良的危险因素.结果 共纳入患者96例,主要见于>50岁的中老年患者,平均年龄为54.47岁,以男性患者居多,临床表现以局灶性症状多见,74.0%的患者为隐源性感染来源,37.5%的患者为多发性脑脓肿,85.4%的患者预后良好.Logistic多因素分析结果显示,GCS评分下降和脓肿临近脑室是脑脓肿患者出院时预后不良的危险因素.共有15株病原菌分离自38例经手术治疗的脑脓肿患者脓液标本,其中大多数分离菌株对临床常用抗菌药物具有较好的敏感性.结论 脑脓肿常见于中老年男性患者,其中隐源性脑脓肿更为常见,临床表现具有不典型性,所分离菌株对临床常用抗菌药物的耐药率较低,GCS评分下降和脓肿临近脑室是脑脓肿患者预后不良的危险因素.Objective To analyze the clinical and microbiological characteristics and prognostic factors of brain abscesses,so as to provide reference for early diagnosis and correct treatment of brain abscesses.MethodsThe clinical data of patients diagnosed with brain abscess from the First Afiliated Hospital of Wenzhou Medical University from 2012 to 2019 were retrospectively analyzed.The MALDI-TOF-MS microbial identification system and VITEK 2 Compact automatic microbial analysis system were used for strain identification and antimicrobial susceptibility testing,and the clinical outcomes of patients with brain abscess were analyzed and compared to find risk factors for their poor prognosis.ResultsA total of 96 patients were included,with the majority being middle-aged and senior patients of>50 years old,with an average age of 54.47 years old,and the majority being male patients.The clinical manifestations were mostly focal symptoms.74.0% of patients had cryptogenic infection,37.5%of patients had multiple brain abscesses,and 85.4%of patients had a good prognosis.In addition,Logistic multivariate analysis results suggested that the decreased GCS score and the proximity of abscesses to the ventricles were risk factors for poor prognosis in patients with brain abscesses.A total of 15 strains of pathogenic bacteria were isolated from the pus samples of38 patients with brain abscess treated by operation,and the most of them had good sensitivity to antibiotics that were commonly used in clinic.ConclusionThe brain brain abscesses were common in middle-aged and elderly people,cryptogenic brain abscesses were more common and the clinical manifestations were not typical.The isolated strains had a low resistance to commonly used clinical antibiotics.The decline in GCS scores and the proximity of the abscesses to the ventricles were risk factors for poor prognosis inpatientswithbrainabscess.

关 键 词：脑脓肿 隐源性 病原菌 危险因素 GCS评分 脓肿临近脑室 

分 类 号：R651[医药卫生—外科学]