碳青霉烯耐药革兰阴性杆菌致严重颅内感染治疗的临床研究  

A clinical study on the treatment of severe intracranial infection caused by carbapenem-resistant Gram-negative bacilli

作　　者：李庆岗 程岗 孙君昭 张剑宁 刘如恩 李小勇 Li Qinggang;Cheng Gang;Sun Junzhao;Zhang Jianning;Liu Ruen;Li Xiaoyong(Department of Neurosurgery,Second Clinical Medical College of Peking University People's Hospital,Beijing 100044,China;Department of Neurosurgery,Beijing Beiya Orthopedics Hospital,Beijing 102445,China;Department of Neurosurgery,Medical College,General Hospital of PLA,Beijing 100039,China)

机构地区：[1]北京大学人民医院第二临床医学院神经外科,北京100044 [2]北京北亚骨科医院神经外科,北京102445 [3]解放军总医院神经外科医学部,北京100039

出　　处：《中国微侵袭神经外科杂志》2024年第2期75-80,共6页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：全军医学科技青年培育基金(编号:17QNP014)。

摘　　要：目的探讨神经外科术后颅内继发碳青霉烯耐药革兰阴性杆菌(carbapenem-resistant Gram-negative bacilli,CRGNB)感染的病原体耐药状况、治疗方法和预后情况。方法回顾性分析54例确诊的CRGNB感染病例资料,通过静脉滴注多黏菌素、替加环素和脑室内注射多黏菌素,并持续脑脊液引流治疗,总结并分析临床疗效。结果严重颅内感染病人54例,其中颅内感染合并脑积水44例(81.48%)占比最高。感染细菌中鲍曼不动杆菌感染29例(53.70%),肺炎克雷伯菌感染22例(40.74%),铜绿假单胞菌感染2例(3.70%),阴沟肠杆菌1例(1.85%)。经治疗后感染好转17例(31.48%),感染控制27例(50.00%),总有效率为81.48%。鲍曼不动杆菌、肺炎克雷伯菌为占比最高的两种感染菌,病人在感染转归方面差异无统计学意义(P>0.05)。结论CRGNB感染病人病情较重,细菌为多重耐药菌,以鲍曼不动杆菌和肺炎克雷伯菌感染多见,并发症多,治疗难度大,应尽早、积极选择静脉与脑室联合用药,并行有效的脑脊液引流治疗,尽快控制细菌感染,改善病人预后和提高生存率。Objective To investigate the drug resistance status,treatment methods,and prognosis of intracranial secondary carbapenem-resistant Gram-negative bacilli(CRGNB)infection after neurosurgical operations.Methods The clinical data of 54 patients confirmed cases of CRGNB infection were analyzed retrospectively.The intravenous administration of polymyxin,tigecycline,and intraventricular injection of polymyxin were combined with continuous cerebrospinal fluid drainage therapy.The clinical outcomes were summarized.Results Among the 54 patients with severe intracranial infections,44(81.48%)had intracranial infection complicated with hydrocephalus,accounting for the highest proportion.Acinetobacter baumannii infection was seen in 29 cases(53.70%),Klebsiella pneumoniae infection in 22(40.74%),Pseudomonas aeruginosa infection in 2(3.70%),and Enterobacter cloacae infection in 1 case(1.85%).After treatment,17 patients(31.48%)showed improvement,and 27(50.00%)achieved infection control,with an overall response rate of 81.48%.Acinetobacter baumannii and Klebsiella pneumoniae were the two infectious bacilli with the highest proportions,there was no statistically significant difference in infection outcomes between Acinetobacter baumannii and Klebsiella pneumoniae infections(P>0.05).Conclusions CRGNB infections are severe,with bacteria being multidrug-resistant,commonly represented by Acinetobacter baumannii and Klebsiella pneumoniae infections.Patients often experience complications,making treatment challenging.Therefore,intravenous and intraventricular combined medication should be selected as early as possible,and at the same time,effective cerebrospinal fluid drainage should be also performed to control bacterial infection as soon as possible,improving patient prognosis and enhancing survival rates.

关 键 词：碳青霉烯类耐药 革兰阴性杆菌 颅内感染 严重 转归 

分 类 号：R742.7[医药卫生—神经病学与精神病学]