摘要
目的探索耐碳青霉烯类肺炎克雷伯菌颅内感染治疗经验。方法总结解放军总医院神经外科2017年2月收治的1例耐碳青霉烯类肺炎克雷伯菌颅内感染病人的药物治疗方案和感染灶控制方案。结果病人主诉癫痫发作1月余。术前诊断:右颞脑动静脉畸形(AVM),继发性癫痫。入院2 d后行脑血管造影,6 d后导航下行右颞AVM切除术。术后病人出现脑室内出血、颅内感染、感染性休克。脑脊液病原学检查结果为耐碳青霉稀类的肺炎克雷伯菌,静脉注射替加环素、阿米卡星,联合鞘内注射阿米卡星,结合复方磺胺甲噁唑、米诺环素等口服药物;结合腰大池引流、脓肿穿刺等感染灶控制方案,成功救治病人。结论长疗程的静脉注射抗菌药物结合足量的鞘内/脑室内氨基糖苷类药物使用和炎性脑脊液持续引流是耐碳青霉烯类肺炎克雷伯菌颅内感染治疗的关键。
Objective To explore the experience of treatment of carcinogenic effects of carbapenem-resistant klebsiella pneumoniae.Methods The drug treatment plan and infection control plan for a patient with intracranial infection of carbapenem-resistant klebsiella pneumonia in the Department of Neurosurgery,Chinese PLA General Hospital in February 2017 were collected and summarized.Results The patient complained of seizures for more than one month.Preoperative diagnosis results showed that patient has right phrenic arteriovenous malformation(AVM) and secondary epilepsy.Cerebral angiography was performed 2 days after admission,and after 6 days,the right axillary AVM was performed.Postoperative patient developed intraventricular hemorrhage,intracranial infection,and septic shock.The pathogenic examination results showed cerebrospinal fluid with intracranial infection of carbapenem-resistant klebsiella pneumonia.This patient was cured by a combined method including intravenous tigecycline,amikacin,intrathecal amikacin,oral drugs like sulfamethoxazole and minocycline,with surgical methods as lumbar drain and abscess puncture.Conclusion The long course of intravenous antibiotics combined with the use of sufficient intrathecal/intraventricular aminoglycosides and continuous drainage of inflammatory cerebrospinal fluid are the key to the treatment of carbapenem-resistant klebsiella intracranial infections.
作者
陈玥
郭冬杰
李朋梅
CHEN Yue;GUO Dongjie;LI Pengmei(Center of Clinical Pharmacy,Chinese PLA General Hospital,Beijing 100853,China;Department of Pharmacy,China-Japan Friendship Hospital,Beijing 100031,China)
出处
《安徽医药》
CAS
2019年第8期1617-1620,共4页
Anhui Medical and Pharmaceutical Journal
关键词
中枢神经系统细菌感染
克雷伯菌感染
耐碳青霉烯类肺炎克雷伯菌
注射
脊髓
颅内动静脉畸形
脑脓肿
Central nervous system bacterial infections
Klebsiella infections
Carbapenem-resistant klebsiella pneumonia
Injections,spinal
Intracranial arteriovenous malformations
Brain abscess
