院内鲍曼不动杆菌颅内感染的临床病例分析

发布时间：2018-07-12 14:59

本文选题：鲍曼不动杆菌 + 耐药　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:通过分析我院鲍曼不动杆菌(Acinetobacter baumannii,Ab)颅内感染患者的临床特点、脑脊液(Cerebro-Spinal Fluid,CSF)生化指标,探讨鲍曼不动杆菌耐药情况及治疗预后情况,为临床抗感染防治提供可靠的理论依据。方法:查阅安徽医科大学第一附属医院各科室2013年9月-2016年9月脑脊液鲍曼不动杆菌感染病例档案,收集患者的基本资料、发病特点、脑脊液常规及生化检查和临床微生物药敏检测报告,去除假阳性及可能污染病例,采用细菌耐药监测网软件WHONET 5.6和SPSS 16.0进行统计学分析。结果:1.我院脑脊液培养阳性的病原菌种类繁多,其中革兰氏阴性菌170株(占66.1%),革兰氏阳性菌73株(占28.4%),真菌14株(占5.5%)。其中鲍曼不动杆菌所占比例最大,共91株(占35.4%),91株共来自于39例鲍曼不动杆菌脑膜炎患者。2.鲍曼不动杆菌感染引发的细菌性脑膜炎在我院科室分布较为广泛,其中以神经外科(69.2%)、重症监护病室(Intensive Care Unit,ICU)(20.5%)和神经内科(7.7%)较多见。3.本次调查共39例最终确诊为鲍曼不动杆菌感染脑膜炎患者,均接受过神经外科手术或其他颅脑侵入操作,临床特点如下:年龄2-76岁,平均(46.31±16.41);性别(男27人,女12人)。原发性疾病主要有脑出血(48.7%)、颅脑意外(38.5%)、脑肿瘤(10.3%);基础疾病主要为高血压(35.9%)、糖尿病(10.3%);几乎所有患者均有不同程度的发热和头痛,绝大多数患者表现为意识障碍(87.2%),有相当数量癫痫发作患者(41.0%)。4.脑脊液检测结果中白细胞计数明显升高(4652.48±9765.32)*106/L;红细胞计数多(2384.17±6576.74)*106/L;多形核比占(90.18±7.94%);CL-含量偏低(111.12±8.12)mmol/l;蛋白定量升高(3.05±1.29)g/l;葡萄糖含量降低(2.27±1.06)mmol/l。5.39名患者脑脊液标本中共分离培养出91株鲍曼不动杆菌,对28种我院常用抗菌药物出现不同程度耐药,其中阿米卡星耐药率(51.95%)、米诺环素耐药率(32.65%)、替加环素耐药率(43.4%)和头孢哌酮/舒巴坦耐药率(47.83%),耐药率较低。常用抗菌药物美罗培南耐药率高达(90.91%)。6.39例鲍曼不动杆菌脑膜炎患者在脑脊液病原学结果公布前,均根据患者临床表现的严重程度及脑脊液常规和生化结果进行经验性抗感染治疗,以美罗培南或三代头孢联合万古霉素治疗较多见。其中单一使用三、四代头孢的患者有6例,三、四代头孢联合万古霉素抗感染治疗8例,美罗培南联合万古霉素13例,其他治疗12例。颅内感染患者多数行脑脊液引流术,主要以腰大池引流及侧脑室引流为主,部分患者行皮瓣下引流等,有4例患者因腰大池引流管堵塞而改为侧脑室引流,有3例患者因颅内感染控制持续性脑积水而行永久性脑室腹腔内引流术。脑脊液病原学及药敏结果发布后,则根据药敏结果及患者临床症状,以美罗培南为主的联合治疗有10例、亚胺培南为4例、替加环素为8例、头孢哌酮舒巴坦为10例、头孢曲松为5例。7.39名鲍曼不动杆菌脑膜炎患者经我院治疗,痊愈8名(20.5%)、显效6名(15.4%)、有效7名(18.0%)、无效18名(46.1%)。结论:鲍曼不动杆菌脑膜炎多发生在神经外科颅脑侵入性操作后,临床症状重,鲍曼不动杆菌耐药率高,对常用抗菌药物普遍耐药,感染防治形势格外严峻。加强临床管理,进行细菌耐药性监测,采用合理用药,以减少耐药菌的产生。
[Abstract]:Objective: through the analysis of the clinical characteristics of Acinetobacter baumannii (Acinetobacter baumannii, Ab) and the biochemical indexes of cerebrospinal fluid (Cerebro-Spinal Fluid, CSF) in our hospital, the drug resistance of Acinetobacter and the prognosis of the treatment were discussed in order to provide a reliable theoretical basis for the prevention and treatment of anti infection in the clinic. A case file of the cerebrospinal fluid (CSF) Acinetobacter Bauman infection in every department of the Affiliated Hospital in September 2013 -2016 September, collecting the basic data of the patients, the characteristics of the disease, the routine and biochemical examination of cerebrospinal fluid and the clinical microbiological drug sensitivity test report, removing false positive and possible pollution cases, using the bacterial resistance monitoring network software WHONET 5.6 and SPSS 16. Results: 1. there were a wide variety of pathogenic bacteria in the CSF culture of our hospital, including 170 Gram-negative bacteria (66.1%), 73 Gram-positive bacteria (28.4%) and 14 fungi (5.5%). Among them, the proportion of Acinetobacter Bauman was the largest, 91 (35.4%) and 91 strains of.2. Bauman from the patients with Acinetobacter Bauman meningitis. Bacterial meningitis caused by Acinetobacter infection was widely distributed in the Department of our hospital, including Department of Neurosurgery (69.2%), Intensive Care Unit, ICU (20.5%) and neurology department (7.7%), which were most seen in this investigation, and 39 cases were finally confirmed by Acinetobacter Bauman infected meningitis patients, all accepted the Department of neurosurgery operation or The clinical features of other craniocerebral invasion were as follows: age 2-76 years, average (46.31 + 16.41), sex (27 men and 12 women). Primary diseases were mainly cerebral hemorrhage (48.7%), craniocerebral accident (38.5%), brain tumor (10.3%), basic disease mainly hypertension (35.9%), diabetes (10.3%), almost all patients had different degrees of fever and headache. Most of the patients were characterized by disturbance of consciousness (87.2%), and there was a significant number of epileptic seizures (41%) in.4. cerebrospinal fluid (4652.48 + 9765.32) *106/L, red blood cell count (2384.17 + 6576.74) *106/L, polymorphonuclear nucleus ratio (90.18 + 7.94%), CL- content (111.12 + 8.12) mmol/l, and protein quantitative elevation (3.05 + 1.29). G/l, 91 strains of Acinetobacter Bauman were isolated and cultured in cerebrospinal fluid samples of mmol/l.5.39 patients with glucose content reduction (2.27 + 1.06). The resistance rate of 28 kinds of antibiotics used in our hospital was different, including the Amikacin resistance rate (51.95%), the resistance rate of minocycline (32.65%), tetracycline resistance rate (43.4%) and Cefoperazone / sulbactam resistance Rate (47.83%), the resistance rate was low. The common antimicrobial drug meropenem resistance rate was high (90.91%).6.39 cases of Acinetobacter meningomeningitis patients in the cerebrospinal fluid pathogeny before the release of the patient's clinical manifestations of the severity and cerebrospinal fluid routine and biochemical results of the experimental anti infection treatment, with meropenem or three generation of cephalosporin. Three, four generation cephalosporin had 6, three, four cephalosporin combined with vancomycin, 8, 13, and 12. Most of the patients were treated with cerebrospinal fluid drainage, mainly with large pool drainage and lateral ventricle drainage. 4 patients were replaced by lateral ventricle drainage because of the blockage of the drainage tube of the lumbar and large pools, and 3 patients underwent permanent ventricle intraperitoneal drainage because of the intracranial infection controlling persistent hydrocephalus. After the cerebrospinal fluid etiology and drug sensitivity results were released, the combined treatment of meropenem based on the results of drug sensitivity and the clinical symptoms of the patients. There were 10 cases, 4 imipenem, 8 cases of tegoperazin, 10 cases of cefoperazone sulbactam, 5 cases of ceftriaxone (.7.39) patients with.7.39 meningitis, 8 (20.5%), 6 (15.4%), 7 (18%) and invalid (46.1%). Conclusion: Acinetobacter meningomeningitis in the Department of Neurosurgery mostly occurred in the Department of Neurosurgery invade craniocerebral invasion After the operation, the clinical symptoms are heavy, the drug resistance rate of Acinetobacter Bauman is high and the common antibiotics are generally resistant. The prevention and treatment situation of the infection is particularly severe.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.9

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