神经外科术后多重耐药及泛耐药鲍曼不动杆菌引起化脓性脑室炎的疗效分析  

Therapeutic effect analysis of post-neurosurgical pyogenic ventriculitis caused by multi/extensive drug-resistant Acinetobacter baumannii

作　　者：王柯[1] 姚培文 钱洲棋 冀涛 高亮[1] Wang Ke;Yao Peiwen;Qian Zhouqi;Ji Tao;Gao Liang(Department of Neurosurgery,Shanghai Tenth People's Hospital Affiliated to Tongji University,Shanghai 200072,China)

机构地区：[1]同济大学附属上海市第十人民医院神经外科,上海200072

出　　处：《中华神经外科杂志》2023年第8期808-813,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨脑室灌洗结合脑室内注射多黏菌素治疗神经外科术后多重耐药(MDR)及泛耐药(XDR)鲍曼不动杆菌引起的化脓性脑室炎的疗效。方法回顾性分析2014年1月至2020年6月同济大学附属上海市第十人民医院神经外科收治的神经外科术后MDR/XDR鲍曼不动杆菌引起的化脓性脑室炎患者的临床资料。所有患者均接受脑室灌洗、术后每日脑室内注射多黏菌素,以及替加环素和(或)多黏菌素为基础的全身抗生素联合治疗。出院后行门诊随访。患者的预后以出院3个月时的格拉斯哥预后评分(GOS)评估。结果果研究共纳入39例患者,其中34例(87.2%)获临床治愈后出院,5例死亡。脑室内多黏菌素的应用时长为(24.3±15.3)d(5~65d)。33例(84.6%)患者出现脑积水,其中多腔室脑积水15例,单腔室脑积水18例。与未发生多腔室脑积水的患者相比,发生多腔室脑积水的患者脑室内注射多黏菌素的时长明显增加(31.0±16.6)d对比[(20.1±13.1)d,t=2.29,P=0.028],出院3个月时的COS[中位数(四分位数)]更低[2(2,2)分对比3(2,4)分,Z=-2.47,P=0.017]。感染治愈后30例患者接受脑室-腹腔分流术,2例行腰大池-腹腔分流术,分流术后无一例发生再次感染。结论脑室灌洗结合脑室内注射多黏菌素是治疗神经外科术后MDR/XDR鲍曼不动杆菌引起的化脓性脑室炎的有效方法。脑积水为其常见的并发症,多腔室脑积水的发生可能与患者的不良预后相关。Objective To investigate clinical therapeutic effect of intraventricular lavage and intraventricular administration of polymyxins in post-neurosurgical patients with pyogenic ventriculitis caused by multi/extensive drug-resistant(MDR/XDR)Acinetobacter baumannii.MethodsA retrospective analysis was conducted on the clinical data of patients with post-neurosurgical pyogenic ventriculitis caused by MDR/XDR Acinetobacter baumannii who were admitted to the Neurosurgical Department of Shanghai Tenth People's Hospital affiliated to Tongji University from January 2014 to June 2020.All of the patients underwent intraventricular lavage followed by daily intraventricular polymyxins injection.Intravenous antibiotic strategy was mainly based on tigecycline and/or polymyxins.Outpatient follow-up was performed after discharge.The patient's outcome was assessed by the Glasgow Outcome Scale(GOS)at 3 months after discharge.Results Thirty-nine patients were enrolled in this study.Thirty-four(87.2%)patients were clinically cured and discharged,and 5 patients died.The mean duration of intraventricular administration of polymyxins was 24.3±15.3(5-65)days.Hydrocephalus was present in 33(84.6%)patients,including 15 with muliloculated hydrocephalus and 18 with uniloculated hydrocephalus.The duration of intraventricular injection of polymyxins was significantly longer in patients with multiloculated hydrocephalus than in those without multiloculated hydrocephalus(31.0±16.6 days us.20.1±13.1 days,t=2.29,P=0.028),and the GOS score was significantly lower than in patients with multiloculated hydrocephalus than in those without multiloculated hydrocephalus[2(2,2)us.3(2,4),Z=-2.47,P=0.017].After the cure of infection,30 patients underwent ventriculo-peritoneal shunt,and 2 patients received lumbar-peritoneal shunt.No recurrence of infection occurred in any patients after shunt.Conclusions Intraventricular lavage combined with intraventricular injection of polymyxins is an effective way for the treatment of post-neurosurgical pyogenic ventricu

关 键 词：脑室炎 鲍氏不动杆菌 预后 多黏菌素 注射 脑室内 脑室灌洗 

分 类 号：R651.1[医药卫生—外科学] R446.5[医药卫生—临床医学]