住院患者脑脊液病原菌分布及其耐药分析

doi:10.3969/j.issn.1672-6731.2020.05.014

摘要/Abstract

摘要：

目的对住院患者脑脊液病原菌分布及药敏试验结果进行回顾分析，为合理用药提供科学依据。方法采集2016年1月至2018年6月2653例颅内感染患者2733份脑脊液标本，分别行细菌鉴定和药敏试验。结果共分离获得致病性病原菌207株，阳性检出率7.57%（207/2733）。其中，革兰阴性杆菌115株占57.21%（115/207），包括鲍曼不动杆菌51株、大肠埃希菌23株、铜绿假单胞菌17株、肺炎克雷伯菌12株、阴沟肠杆菌7株、其他5例；革兰阳性球菌86株占41.55%（86/207），分别为凝固酶阴性葡萄球菌25株、金黄色葡萄球菌23株、肺炎链球菌19株、肠球菌16株、其他3株；革兰阳性杆菌1株；真菌5株。革兰阴性杆菌对青霉素类和头孢菌素类耐药率>30%，革兰阳性球菌对大环内酯类耐药率>40%。结论颅内感染致病菌分布广泛、耐药率较高，应严密监测住院病例细菌耐药情况，合理应用抗生素。

关键词: 脑脊髓液, 细菌, 交叉感染, 药物耐受性, 住院病人

Abstract:

Objective Retrospective analysis of the distribution of cerebrospinal fluid (CSF) pathogens and drug sensitivity test results in hospitalized neurosurgery patients, to provide a scientific basis for rational drug use. Methods A total of 2733 CSF specimens were collected from 2653 hospitalized patients with intracranial infection for bacterial identification and drug sensitivity tests from January 2016 to June 2018. Results A total of 207 pathogenic bacteria were isolated and the positive detection rate was 7.57% (207/2733). Among them, 115 strains of Gram-negative bacilli accounted for 57.21% (115/207), including 51 strains of Acinetobacter baumannii, 23 strains of Escherichia coli, 17 strains of Pseudomonas aeruginosa, 12 strains of Klebsiella pneumoniae, 7 strains of Enterobacter and other 5 cases; 86 strains of Gram-positive cocci accounted for 41.55% (86/207), 25 strains of Coagulase-negative staphylococci, 23 strains of Staphylococcus aureus, 19 strains of Streptococcus pneumoniae, 16 strains of Enterococcus, and other 3 cases; 1 strains of Gram-positive bacterium; 5 strains of Fungi. The resistance rates of Gram-negative bacilli to penicillins and cephalosporins were over 30%. The resistance rates of Gram-positive cocci to macrolides were over 40%. Conclusions Pathogens of intracranial infection were widely distributed and the rate of drug resistance was high. The drug resistance of hospitalized patients should be closely monitored and antibiotics should be used reasonably.

Key words: Cerebrospinal fluid, Bacteria, Cross infection, Drug tolerance, Inpatients

孙登彬, 王猛, 郭烨. 住院患者脑脊液病原菌分布及其耐药分析[J]. 中国现代神经疾病杂志, 2020, 20(5): 455-459.

SUN Deng-bin, WANG Meng, GUO Ye. Distribution and drug resistance of cerebrospinal fluid pathogenic bacteria in hospitalized patients[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(5): 455-459.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I5/455

参考文献

[1] Brouwer MC, van de Beek D. Management of bacterial central nervous system infections[J]. Handb Clin Neurol, 2017, 140:349-364.
[2] Melvin AJ, Mohan KM, Schiffer JT, Drolette LM, Magaret A, Corey L, Wald A. Plasma and cerebrospinal fluid herpes simplex virus levels at diagnosis and outcome of neonatal infection[J]. J Pediatr, 2015, 166:827-833.
[3] Sailer AM, Grutters JP, Wildberger JE, Hofman PA, Wilmink JT, van Zwan WH. Cost-effectiveness of CTA, MRA and DSA in patients with non-traumatic subarachnoid haemorrhage[J]. Insights Imaging, 2013, 4:499-507.
[4] Shi CN, Zheng GH, Zhao YZ, Zhang GJ. The application of cerebrospinal fluids routine for intracranial infection[J]. Zhongguo Shi Yong Shen Jing Bing Xue Za Zhi, 2018, 21:1330-1333.[史从宁, 郑光辉, 赵运转, 张国军. 脑脊液常规在颅内感染中的应用[J]. 中国实用神经病学杂志, 2018, 21:1330-1333.]
[5] Sun CG, Cheng J, Yang Y. Interpretation of the main update content of CLSI M100-S25 document in 2015[J]. Zhonghua Jian Yan Yi Xue Za Zhi, 2015, 33:241-245.[孙长贵, 成军, 杨艳. 2015年CLSI M100-S25文件主要更新内容解读[J]. 中华检验医学杂志, 2015, 33:241-245.]
[6] van de Beek D, Cabellos C, Dzupova O, Esposito S, Klein M, Kloek AT, Leib SL, Mourvillier B, Ostergaard C, Pagliano P, Pfister HW, Read RC, Sipahi OR, Brouwer MC; ESCMID Study Group for Infections of the Brain (ESGIB). ESCMID guideline:diagnosis and treatment of acute bacterial meningitis[J]. Clin Microbiol Infect, 2016, 22 Suppl 3:37-62.
[7] Cui XL, Yu HE, Wang YG, Lin S, Liu LH. Distribution and antimicrobial resistance analysis of pathogens in CSF of postoperative CNS infection[J]. Yao Wu Liu Xing Bing Xue Za Zhi, 2015, 24:33-37.[崔向丽, 于洪娥, 王永刚, 林松, 刘丽宏. 神经外科术后感染脑脊液病原菌分布及耐药变化特点[J]. 药物流行病学杂志, 2015, 24:33-37.]
[8] Cui T, Shi BZ, Xu DX. Characteristics and drug resistance analysis of pathogenic of postoperative intracranial infection in neurosurgical patients[J]. Zhonghua Yi Yuan Gan Ran Xue Za Zhi, 2015, 25:3428-3430.[崔涛, 史宝中, 徐东晓. 神经外科患者术后颅内感染病原菌特点与耐药性分析[J]. 中华医院感染学杂志, 2015, 25:3428-3430.]
[9] Abecassis IJ, Adel JG, Ayer A, Batjer HH. A ruptured infectious intracranial aneurysm with a combined fungal and bacterial etiology[J]. Clin Neurol Neurosurg, 2013, 115:2393-2396.
[10] Jeong TS, Yee GT. Prospective multicenter surveillance study of surgical site infection after intracranial procedures in Korea:a preliminary study[J]. J Korean Neurosurg Soc, 2018, 61:645-652.
[11] San-Juan R, Fernández-Ruiz M, Gasch O, Camoez M, López-Medrano F, Domínguez M Á, Almirante B, Padilla B, Pujol M, Aguado JM; REIPI/GEIH Study Group. High vancomycin MICs predict the development of infective endocarditis in patients with catheterrelated bacteraemia due to methicillin-resistant Staphylococcus aureus[J]. J Antimicrob Chemother, 2017, 72:2102-2109.
[12] Ramachandran P, Fitzvvatej SP, Aneja S, Verghese VP, Kumar V, Nedunchelian K, Wadhwa N, Veeraraghavan B, Kumar R, Meeran M, Kapil A, Jasmine S, Kumar A, Suresh S, Bhatnagar S, Thomas K, Awasthi S, Santosham M, Chandran A. Prospective multi-centre sentinel surveillance for Haemophilus influenzae type b & other bacterial meningitis in Indian children[J]. Indian J Med Res, 2013, 137:712-720.
[13] Shen XM, Wang X, Gao AM, Liang HL, Xu HQ. Distribution and drug resistance of pathogens causing intracranial infection[J]. Zhonghua Yi Yuan Gan Ran Xue Za Zhi, 2016, 26:591-593.[申学明, 王序, 高安明, 梁洪磊, 许红旗. 颅内感染患者病原菌分布与耐药性监测[J]. 中华医院感染学杂志, 2016, 26:591-593.]
[14] Longo F, Vuotto C, Donelli G. Biofilm formation in Acinetobacter baumannii[J]. New Microbiol, 2014, 37:119-127.
[15] Özvatan T, Akalin H, Sinirtas M, Ocakoglu G, Y?lmaz E, Heper Y, Kelebek N, I?çimen R, Kahveci F. Nosocomial Acinetobacter pneumonia:treatment and prognostic factors in 356 cases[J]. Respirology, 2016, 21:363-369.
[16] Mohammadi M, Khayat H, Sayehmiri K, Soroush S, Sayehmiri F, Delfani S, Bogdanovic L, Taherikalani M. Synergistic effect of colistin and rifampin against multidrug resistant Acinetobacter baumannii:a systematic review and Meta-analysis[J]. Open Microbiol J, 2017, 11:63-71.
[17] Pokhrel RH, Thapa B, Kafle R, Tribuddhara C. Co-existence of beta-lactamases in clinical isolates of escherchia coli from Kathmandu, Nepal[J]. BMC Res Notes, 2014, 7:694.
[18] Chiu CY. Viral pathogen discovery[J]. Curr Opin Microbiol, 2013, 16:468-478.
[19] Laman M, Hwaiwhanje I, Bona C, Warrel J, Aipit S, Smith D, Noronha J, Siba P, Mueller I, Betuela I, Davis TM, Manning L. Viral pathogens in children hospitalized with features ofcentral nervous system infection in a ma laria-endemic region of Papua New Guinea[J]. BMC Infect Dis, 2014, 14:630.
[20] Maskerine C, Loeb M. Improving adherence to hand hygiene among health care workers[J]. J Contin Educ Health Porf, 2006, 26:244-251.

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