摘要
目的研究颅脑损伤患者脑脊液培养菌分布及耐药性,比较不同细菌引起颅内感染指标差异。方法回顾性分析医院2010年1月-2015年12月脑脊液培养阳性患者314例的临床资料,对5 100份脑脊液标本分离菌株进行菌种鉴定及药敏试验,统计不同种类细菌颅内感染指标差异,探讨脑脊液同种细菌培养阳性次数对于评估颅内感染病原菌临床意义。结果送检脑脊液5 100份共培养分离细菌532株,剔除重复菌株后为314株。其中革兰阳性菌243株占77.39%,以凝固酶阴性葡萄球菌217株为主(其中头状葡萄球菌76株,溶血葡萄球菌51株,表皮葡萄球菌35株);革兰阴性菌71株占22.61%,以鲍氏不动杆菌28株为主;脑脊液分离病原菌中以凝固酶阴性葡萄球菌为主。葡萄球菌属对万古霉素、替考拉宁及利奈唑胺高度敏感,鲍氏不动杆菌多药耐药现象严重,除多黏菌素其余抗菌药物耐药率均>60%。革兰阴性菌与革兰阳性菌导致颅内感染中脑脊液白细胞数(WBC)、多核细胞比例(NEUT%)、脑脊液的葡萄糖(GLU)、总蛋白(CSF-Pr)、氯离子(CL)、腺苷脱氨酶(ADA)含量差异有统计学意义(P<0.05)。患者脑脊液同种细菌多次培养阳性较单次培养阳性部分感染指标差异有统计学意义(P<0.05)。结论颅脑损伤患者脑脊液分离细菌主要以凝固酶阴性葡萄球菌为主,革兰阴性菌引起颅内感染多项指标较革兰阳性菌有显著差异,脑脊液同种细菌多次培养阳性对于评估颅内病原菌有重要意义。
OBJECTIVE To analyze the distribution and drug resistant profile of bacteria isolated from cerebrospinal fluid(CSF) in craniocerebral injury patients, and investigate the change of intracranial infection-related indexes caused by different bacteria. METHODS The clinical data of 314 patients whose CSF culture was positive with bacteria from Jan. 2010 to Dec. 2015 were retrospectively analyzed. Bacteria identification and antimicrobial susceptibility tests were performed for the bacteria isolated from 5100 CSF samples. The difference of the CSF-related indexes caused by different bacteria was analyzed. The clinical significance of the frequency of positive bacterial culture in CSF in evaluating the pathogenic bacteria of intracranial infection was analyzed. RESULTS 532 strains of bacteria were isolated from the 5,100 samples of cerebrospinal fluid and 314 strains after eliminating the repetitive strains. Among them, 243 strains of gram-positive bacteria accounted for 77.39%, of which 217 strains were coagulase-negative Staphylococcus(76 strains of Staphylococcus capitis, 51 strains of Staphylococcus hemolyticus and 35 strains of Staphylococcus epidermidis);71 strains of gram-negative bacteria accounted for 22.61%, 28 strains of mainly Acinetobacter baumannii;coagulase-negative Staphylococcus was the main pathogen isolated from cerebrospinal fluid. Staphylococcus was highly susceptible to vancomycin, teicoplanin and linezolid. A.baumannii had serious multidrug resistance. The resistance rates of other antimicrobial agents except polymyxin were more than 60%. There were significant differences in white blood cell(WBC), proportion of multinuclear cells(NEUT%), glucose(GLU), total protein(CSF-Pr), chloride ion(CL) and adenosine deaminase(ADA) contents between patients with intracranial infections caused by gram-negative bacteria and gram-positive bacteria(P<0.05). There was a significant difference in some infection-related indexes between multiple culture positive and single culture positive of the same bacteria(P<0.05). CONCLUSION The dominant bacteria isolated from CSF were coagulase-negative Staphylococcus. Part of the intracranial infection indexes showed significant difference in the patients with intracranial infections caused by gram-negative bacteria or gram-positive bacteria. Multiple culture positive of the same bacteria in CSF was important for clinical assessment of intracranial pathogenic bacteria.
作者
胡丽华
殷一萍
余诗芬
张冉利
孙龙
HU Li-hua;YIN Yi-ping;YU Shi-fen;ZHANG Ran-li;SUN Long(Hangzhou General Hospital of Chinese People's Armed Police Forces,Hongzhou , Zhejiang 310051, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第13期1980-1984,1992,共6页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生研究计划基金资助项目(2016KYA158)
关键词
颅内感染
多药耐药
病原菌
感染指标
凝固酶阴性葡萄球菌
Intracranial infection
Multi-drug resistance
Pathogenic bacteria
Infection index
Coagulase-negative Staphylococcus
