神经外科患者术后颅内感染病原菌与耐药性分析

发布时间：2018-09-13 16:50

【摘要】：目的探讨神经外科患者术后颅内感染的病原菌分布及耐药性,以降低感染率。方法选取2012年1月-2014年1月医院神经外科收治的患者1 900例作为研究对象,采集患者脑脊液(CSF)进行细菌培养和耐药试验;选取2015年1-8月入院神经外科患者40例,分别于手术当天术后第1、3、7d用无菌棉拭子采集头皮标本,进行培养并检测药物敏感性。结果 1 900例患者共有179例发生颅内感染,感染率为9.42%,CSF中检出病原菌163株,革兰阳性菌119株占73.01%,革兰阴性菌44株占26.99%;收集40例患者160份头皮标本,共培养病原菌160株,其中以革兰阳性菌143株占89.37%,革兰阴性菌5株占3.13%,真菌12株占7.5%;CSF中的革兰阳性菌对万古霉素敏感,未检出耐药菌株,头皮标本中对万古霉素同样敏感,仅检出5株耐药菌,耐药率3.13%;CSF中耐药性较高的为苯唑西林和青霉素,耐药率分别为83.19%和79.83%,头皮标本中对青霉素全部耐药;CSF中的革兰阴性菌耐药性最高的为卡那霉素,耐药率为52.27%,头皮标本中的革兰阴性菌仅5株,均对头孢吡肟和头孢他啶100.00%耐药。结论革兰阳性菌尤其是凝固酶阴性葡萄球菌和金黄色葡萄球菌是引起颅内感染的重要因素,临床应在术前或术中使用针对革兰阳性菌的广谱抗菌药物。
[Abstract]:Objective To investigate the distribution and drug resistance of pathogenic bacteria in postoperative intracranial infection of neurosurgical patients in order to reduce the infection rate.Methods 1 900 patients admitted to the Department of neurosurgery in our hospital from January 2012 to January 2014 were selected as the study subjects, and cerebrospinal fluid (CSF) was collected for bacterial culture and drug resistance test. Results 179 cases (9.42%) of 1 900 patients had intracranial infection, 163 strains of pathogenic bacteria were detected in CSF, 119 strains of Gram-positive bacteria accounted for 73.01%, 44 strains of Gram-negative bacteria accounted for 26.99%; 40 cases (160 heads) were collected. In skin samples, 160 pathogenic bacteria were cultured, of which 143 were Gram-positive bacteria, 5 were gram-negative bacteria, 3.13% were gram-negative bacteria, and 12 were fungi. Gram-positive bacteria in CSF were sensitive to vancomycin, but no drug-resistant strains were detected. Only 5 were resistant to vancomycin in scalp samples, with a drug resistance rate of 3.13%. The resistance rates of oxacillin and penicillin were 83.19% and 79.83% respectively, and all of them were resistant to penicillin in scalp specimens. The highest resistance rate of Gram-negative bacteria in CSF was kanamycin, and the resistance rate was 52.27%. Only 5 Gram-negative bacteria in scalp specimens were resistant to cefepime and ceftazidime. Conclusion Gram-positive bacteria, especially coagulation bacteria, were 100.00%. Stem-negative Staphylococcus and Staphylococcus aureus are important factors causing intracranial infection, and broad-spectrum antibiotics against Gram-positive bacteria should be used preoperatively or intraoperatively.
【作者单位】：郑州人民医院神经外科;
【基金】：国家自然科学基金项目(81160522)
【分类号】：R446.5

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