颅脑损伤术后颅内感染脑脊液标本病原菌分布特点及耐药性分析  

Distribution characteristics and drug resistance analysis of pathogenic bacteria in cerebrospinal fluid specimens of patients with postoperative intracranial infection after traumatic brain injury

作　　者：李文静[1] 孙炜[2] 方和 邱教学 姜璐璐[2] LI Wenjing;SUN Wei;FANG He;QIU Jiaoxue;JIANG Lulu(Department of Neurology,Qingdao Haici Hospital(Qingdao Hospital of Traditional Chinese Medicine)Affiliated to Qingdao University,Qingdao 266000,Shandong,China;Department of Neurology,Qingdao Third People's Hospital Affiliated to Qingdao University;Department of Neurology,Yantaishan Hospital)

机构地区：[1]青岛大学附属青岛市海慈医院(青岛市中医医院)神经内科,山东青岛266000 [2]青岛大学附属青岛市第三人民医院神经内科 [3]烟台市烟台山医院神经内科

出　　处：《中国病原生物学杂志》2024年第10期1211-1214,共4页Journal of Pathogen Biology

摘　　要：目的 探析颅脑损伤术后并发颅内感染患者脑脊液标本病原菌分布特点及耐药性。方法 选取2021-2023年110例颅脑损伤术后并发颅内感染者为研究对象,采集患者脑脊液标本经培养后进行药敏试验分析,对比革兰阳性菌与革兰阴性菌感染患者脑脊液GLU、ADA、Cl水平。结果 颅内感染组患者与对照组患者在性别、切口脑脊液漏、机械通气、胃管鼻饲介入等差异无统计学意义(P>0.05),在年龄、术前GCS评分、手术时间、气管插管等差异有统计学意义(P<0.05)。110例感染者检出病原菌110株,其中革兰阳性菌72株,革兰阴性菌28株。革兰阳性菌主要为头状葡萄球菌(24.55%,27/110),金黄色葡萄球菌、溶血葡萄球菌、表皮葡萄球菌分别占13.64%(15/110)、10%(11/110)、8.18%(9/110)。革兰阴性菌主要为鲍曼不动杆菌(10%,11/110),肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌占比依次为6.36%(7/110)、5.45%(6/110)、4.55%(5/110)。头状葡萄球菌耐药率从高到低依次为:苯唑西林(100%,27/27)、克林霉素(100%,27/27)、青霉素(92.59%,25/27)、红霉素(85.19%,23/27)、左氧氟沙星(66.67%,18/27)、复方新诺明(62.96%,17/27)、头孢呋辛(59.26%,16/27)、诺氟沙星(55.56%,15/27)、庆大霉素(51.85%,14/27),未检出对万古霉素、利奈唑胺、替考拉宁的耐药株。鲍曼不动杆菌耐药率从高到低依次为:哌拉西林/他唑巴坦(90.91%,10/11)、左氧氟沙星(81.82%,9/11)、头孢他啶(72.73%,8/11)、美罗培南(72.73%,8/11)、诺氟沙星(72.73%,8/11)、复方新诺明(72.73%,8/11)、亚胺培南(63.64%,7/11)、四环素(63.64%,7/11)、头孢吡肟(54.55%,6/11)、庆大霉素(54.55%,6/11)、阿米卡星(45.45%,5/11),未检出对多粘菌素的耐药株。革兰阳性菌所致颅内感染者脑脊液GLU水平、Cl水平均显著低于革兰阴性菌感染者,ADA水平显著高于革兰阴性菌感染者,差异均有统计学意义(P<0.05)。结论 颅脑损伤术后并发颅内感染患者平均年Objective The distribution characteristics and drug resistance of pathogenic bacteria in cerebrospinal fluid specimens of patients with postoperative intracranial infection after traumatic brain injury were explored.Methods s110 patients with postoperative intracranial infection after craniocerebral injury 2021 to 2023 were selected as the study subjects.The cerebrospinal fluid samples were collected from patients for pathogen culture and drug sensitivity analysis.The levels of GLU,ADA and CI in cerebrospinal fluid of patients infected with Gram-positive bacteria and Gram-negative bacteria were compared.Results There was no significant difference(P>0.05)between the intracranial infection group and the control group in terms of gender,incision cerebrospinal fluid leakage,mechanical ventilation,and gastric and nasal feeding intervention.However,there was a significant difference(P<0.05)in terms of age,preoperative GCS score,surgical time,and tracheal intubation status.A total of llo strains of were detected from pathogenic bacteria,including 72 strains of Gram positive bacteria and 28 strains of Gram negative bacteria.Among Gram positive bacteria,the main ones were Staphylococcus capitis(24.55%,27/110),while S.aureus,S.hemolysis,and S.epidermidis account for 13.64%(15/110),10%(11/110),and 8.18%(9/110),respectively.Among Gram negative bacteria,the main ones were Acinetobacter baumannii(10%,ll/110),Klebsiella pneumoniae,Escherichia coli,and Pseudomonas aeruginosa,accounting for 6.36%(7/110),5.45%(6/110),and 4.55%(5/110),respectively.The resistance rates of S.capitis to different antibiotics,from high to low,were as follows:oxacillin(100%,27/27),clindamycin(100%,27/27),penicillin(92.59%,25/27),erythromycin(85.19%,23/27),levofloxacin(66.67%,18/27),compound sulfamethoxazole(62.96%,17/27),cefuroxime(59.26%,16/27),norfloxacin(55.56%,15/27),and gentamicin(51.85%,14/27).No resistance to vancomycin,linezolid,or teicoplanin was observed.The resistance rates of A.baumannii to different antibiotics in descending order were pipe

关 键 词：颅脑损伤 颅内感染 脑脊液 病原菌 耐药性 

分 类 号：R651.15[医药卫生—外科学] R446.5[医药卫生—临床医学]