多黏菌素B联合给药治疗神经外科术后多重耐药鲍曼不动杆菌颅内感染的研究  

Application study of combined administration of polymyxin B in the treatment of intracranial infections caused by multidrug-resistant Acinetobacter baumannii after neurosurgical operations

作　　者：李姗姗[1] 侯国阔 铁兴华 张英杰[1] 史倩雲 张立平[1] LI Shanshan;HOU Guokuo;TIE Xinghua;ZHANG Yingjie;SHI Qianyun;ZHANG Liping(Department of Neurosurgery Intensive Care Unit,The Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院神经外科重症监护室,甘肃兰州730030

出　　处：《兰州大学学报(医学版)》2025年第1期46-52,共7页Journal of Lanzhou University(Medical Sciences)

基　　金：兰州市科技计划资助项目(2023-4-24)。

摘　　要：目的探讨多黏菌素B静脉注射(IV)联合脑室内注射(IVT)或鞘内注射(IT)治疗多重耐药鲍曼不动杆菌(MDR-AB)引起的神经外科术后颅内感染的临床效果及安全性。方法回顾性分析2021年5月—2023年5月兰州大学第二医院神经外科重症监护室收治的颅内感染病例。其中,有17例为MDR-AB感染且使用了多黏菌素B治疗,9例采用多黏菌素B IV联合IVT/IT治疗。收集此9例患者的一般资料、抗感染治疗方案、脑脊液检查结果、细菌培养结果、感染指标、28 d死亡率及并发症等资料,评估其接受多黏菌素B IV联合IVT/IT治疗方案的临床疗效及安全性。结果纳入病例中男性8例,女性1例,平均年龄39.89[18,60]岁;经验性抗感染治疗(直到脑脊液培养报告阳性)中位时间为13.33[2,25]d;多黏菌素B静脉治疗中位时间30.11[16,56]d,IVT/IT注射多黏菌素B中位时间19.78[8,42]d,脑脊液培养转阴中位时间12.56[8,17]d;治疗有效率为88.90%,细菌清除率为100.00%,28 d临床死亡率为0,不良反应发生率为22.22%,急性肾损伤1例(11.11%),皮肤色素沉着1例(11.11%),未出现明显神经毒性副作用,无其他过敏反应。结论多黏菌素B IV联合IVT/IT方案治疗MDR-AB导致的颅内感染临床效果显著,不良反应发生率低,安全性相对好。Objective To explore the clinical efficacy and safety of intravenous(IV)administration combined with intraventricular(IVT)or intrathecal(IT)administration of polymyxin B in the treatment of intracranial infection caused by multi-drug resistant Acinetobacter baumannii(MDR-AB).Methods A retrospective analysis was conducted on the cases of intracranial infections admitted to the Neurosurgical Intensive Care Unit of the Second Hospital of Lanzhou University from May 2021 to May 2023.Among them,17 had infections caused by multidrug-resistant Acinetobacter baumannii(MDR-AB)and were treated with polymyxin B.Their clinical data were collected:9 patients were treated with intravenous(IV)administration of polymyxin B combined with intraventricular(IVT)/intrathecal(IT)administration.The general information,anti-infection treatment regimens,results of cerebrospinal fluid examinations,results of bacterial cultures,infection indices,28-day mortality rate,and complications of these 9 patients were collected.The clinical efficacy and safety of these 9 patients who received the treatment regimen of polymyxin B IV combined with IVT/IT were evaluated.Results The 9 included cases,8 males and 1 female,had an average age of 39.89[18,60]years.The median duration of empirical anti-infection treatment(until the positive result of cerebrospinal fluid culture was reported)was 13.33[2,25]days.The median duration of intravenous treatment with polymyxin B was 30.11[16,56]days,median duration of polymyxin B administration via IVT/IT 19.78[8,42]days,and median time for the cerebrospinal fluid culture to turn negative 12.56[8,17]days.The treatment effectiveness rate was 88.90%,the bacterial clearance rate was 100.00%,the 28-day clinical mortality rate was 0,and the incidence of adverse reactions was 22.22%.There was 1 case of acute kidney injury(11.11%)and 1 case of skin pigmentation(11.11%).There were no neurotoxic side effects and no other allergic reactions.Conclusion The clinical efficacy of the regimen of polymyxin B via intravenous(IV)admi

关 键 词：多黏菌素B 脑室内/鞘内注射 多重耐药 鲍曼不动杆菌 颅内感染 

分 类 号：R651.1[医药卫生—外科学] R978.1[医药卫生—临床医学]