摘要
目的:分析胶质瘤患者行开颅手术后脑膜炎和/或菌血症的发生率及脑脊液培养阳性率,并对致病菌、药敏试验结果及临床特征进行分析。方法:回顾性分析2013年1月至2017年12月北京协和医院神经外科胶质瘤患者行开颅手术后合并脑膜炎和/或菌血症的人口学资料、病原学资料及可疑的感染相关危险因素资料。结果:胶质瘤患者开颅手术后脑膜炎发病率为7.73%(14/181),脑膜炎患者中脑脊液培养阳性率为78.57%(11/14),菌血症发病率为2.21%(4/181),脑膜炎合并菌血症发病率为1.10%(2/181)。11例脑脊液培养阳性标本中共检出病原菌20株,革兰氏阳性菌中常见者为表皮葡萄球菌(3株,15.0%)和溶血葡萄球菌(3株,15.0%);革兰氏阴性菌最常见的为肺炎克雷伯杆菌(2株,10.0%)。4例发生菌血症的患者中共检出病原菌5株,3株为肺炎克雷伯杆菌。药敏试验结果显示革兰氏阳性菌多数对万古霉素敏感,对青霉素G耐药;革兰氏阴性菌多数对美罗培南敏感。16名患者经经验性用药及根据药敏试验结果调整用药后预后良好者13人(81.3%),预后差者3人(18.8%),其中2人死亡,1人自动出院。11例合并脑膜炎的患者中,年龄≥50岁者7人(63.6%),男7人(63.6%);病变部位位于额叶者6人(54.5%);胶质瘤WHO分级IV级者6人(54.5%);术前诊断合并有糖尿病者3人(27.3%)。结论:胶质瘤患者开颅手术后有发生脑膜炎及菌血症的可能,临床上应合理地经验性治疗并及时根据药敏试验结果调整抗生素;同时临床医生在制订患者诊疗计划前应综合考虑多方面因素,以更好地实现精准医疗。
Objective： To evaluate the incidence and microbiological profile of meningitis and/or bacteremia after craniotomy in patients with glioma and analyze the risk factors relevant to postoperative meningitis. Methods： All demographic data, etiological data and clinical data for hospitalized patients who underwent craniotomy in Dept. of Neurosurgery of Peking Union Medical College Hospital between Jan. 2013 to Dec. 2017 were recorded. Results： The incidence of post-craniotomy meningitiswas 7.73%, bacteremia was 2.21% and meningitis combined with bacteremia was 1.10%. The positive rate for cerebrospinal fluid culture was 78.57%. Among the 11 cases of meningitis, 20 bacteria were detected, and the most common gram-positive bacteria were： epidermal Staphylococcus（3 case, 15.0%）, and hemolytic Staphylococcus（3 case, 15.0%）; the most common gram-negative one was Klebsiella pneumoniae（2 case, 10.0%）. Among the 5 cases of bacteremia, Klebsiella pneumoniae was the most common one（3 cases, 60.0%）. Most of the gram-positive bacteria were sensitive to vancomycin and were resistant to penicillin G. Most of the gram-negative bacteria were sensitive to the 3 rd generation of cephalosporin and meropenem. Among all the 16 patients, 13 were good in prognosis（81.3%） while 3（18.8%） were poor in prognosis, with 2 deaths and 1 discharged automatically. Among the 11 patients with meningitis, 7 patients（63.6%） were male and 7（63.6%） were older than 50 years old. The lesionsin the 6 patients located in the frontal lobe（54.5%） and the glioma in 6 patients was at WHO grade IV（54.5%）. Three patients were diagnosed as diabetes before the surgery（27.3%）. Conclusion： Postoperative meningitis and bacteremia can occur in patients with glioma. The pathogens and drug susceptibility are different. The risk factors for meningitis after craniotomy should be concerned before making a treatment plan.
作者
王雅宁
王裕
马文斌
WANG Yaning;WANG Yu;MA Wenbin(Department of Neurosurgery, Chinese Academy of Medical Sciences ＆ Peking Union Medical Colleges, Beijing 100730, China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2018年第4期410-414,共5页
Journal of Central South University ：Medical Science
基金
中国医学科学院医学与健康科技创新工程(2016-I2M-2-001)
北京协和医院中青年科研基金(pumch-2016-2.19)~~
