摘要
目的研究脊柱脊髓外科术后脑脊液漏合并感染的病原菌分布及其药物敏感性,并探讨临床治疗策略。方法选取脊柱脊髓外科术后脑脊液漏合并感染患者36例,收集脑脊液标本进行菌株分离、培养及鉴定,并做药敏试验;患者给予全身和局部抗生素治疗,并评价抗感染治疗效果。结果共分离出病原菌39株,其中革兰阳性菌14株(35.9%),以金黄色葡萄球菌、表皮葡萄球菌及溶血性链球菌多见;革兰阴性菌25株(64.1%),主要为肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌及鲍曼不动杆菌。革兰阳性菌对万古霉素的敏感性达100%,对第三代头孢菌素类抗生素敏感率<50%,对大环内酯类、氨基糖苷类、磺胺类抗生素敏感率<10%。革兰阴性菌对美罗培南的敏感性>90%,对第三代头孢菌素类抗生素敏感率<60%,对青霉素类抗生素敏感率<10%。全身治疗采用美罗培南与万古霉素的联合抗感染方案,局部治疗采用腰椎置管引流,鞘内注射万古霉素,所有病例均于4周内得到稳定控制。结论革兰阳性菌和革兰阴性菌在脊柱脊髓外科手术术后脑脊液漏合并感染中均较常见,万古霉素对革兰阳性菌敏感率较高,而革兰阴性菌对美罗培南具有良好的药物敏感性。因此建议该病的治疗采用早期联合静脉滴注美罗培南和万古霉素方案,同时行腰椎置管引流及鞘内注射万古霉素。
Objective To investigate the distribution and drug sensitivity of pathogenic bacteria in patients with cerebrospinal fluid leakage and an infection after spinal surgery and to explore strategies for clinical treatment.MethodsSubjects were 36 patients with cerebrospinal fluid leakage and an infection after spinal surgery.Cerebrospinal fluid samples were collected for isolation,culture,and identification of pathogenic bacteria,and antibiotic sensitivity tests were performed.The patients were treated with systemic and local antibiotic regimens,and clinical outcomes were analyzed.Results A total of 39 strains of pathogenic bacteria were isolated.There were 14 strains of Gram-positive bacteria(35.9%),including Staphylococcus aureus,S.epidermidis,and Streptococcus haemolyticus.There were 25 strains of Gram-negative bacteria(64.1%),including Klebsiella pneumoniae,Escherichia coli,Pseudomonas aeruginosa,and Acinetobacter baumannii.The sensitivity of Gram-positive bacteria to vancomycin was 100%,while their sensitivity to third-generation cephalosporins was less than 50%and their sensitivity to macrolides,aminoglycosides,and sulfonamides was less than 10%.The sensitivity of Gram-negative bacteria to meropenem was>90%while their sensitivity to thirdgeneration cephalosporins was less than 60%and their sensitivity to penicillin antibiotics was less than 10%.The combined anti-infection regimen using intravenous meropenem and intravenous vancomycin was used for systemic treatment,and lumbar drainage with intrathecal injection of vancomycin was used for local treatment.Complete control of the infection was achieved in all cases within 4 weeks after treatment.Conclusion Both Gram-positive bacteria and Gram-negative bacteria are common in patients with cerebrospinal fluid leakage and an infection after spinal surgery.Gram-positive bacteria were sensitive to vancomycin,and Gram-negative bacteria were highly sensitive to meropenem.We recommend early intravenous use of meropenem and vancomycin,combined with lumbar drainage and intra
作者
杨辰龙
VanHalm-Lutterodt Nicholas
梁辰
刘铁
徐宇伦
刘晓光
YANG Chen-long;Van Halm-Lutterodt Nicholas;LIANG Chen;LIU Tie;XU Yu-lun;LIU Xi-ao-guang(Orthopedics,Peking University Third Hospital,Beijing,China100191;Neurosurgery,Beijing Tiantan Hospital,Capital Medical University)
出处
《中国病原生物学杂志》
CSCD
北大核心
2020年第3期327-331,共5页
Journal of Pathogen Biology
基金
国家自然科学基金面上资助项目(No.81641103)
中国博士后科学基金面上资助项目(No.2018M630047)。
关键词
脊柱脊髓外科
脑脊液漏
感染
病原菌
抗生素
药敏
spinal surgery
cerebrospinal fluid leakage
infection
pathogenic bacteria
antibiotic
drug sensitivity
