CAJ | 학술논문

目的探讨神经外科ICU耐药鲍曼不动杆菌颅内感染的治疗方案.方法对南方医科大学南方医院神经外科重症监护病房(NSICU)收治的鲍曼不动杆菌颅内感染13例的临床资料进行回顾性分析,包括一般情况、原发疾病、感染部位、感染原因、药物敏感性、治疗方案及治疗结果.结果 13例均为耐药鲍曼不动杆菌感染,脑膜炎4例,脑室炎9例;感染原因:脑脊液切口漏7例,脑室外引流3例,血流感染逆行2例,腰大池引流1例;多重耐药(MDRAB)4例,泛耐药(XDRAB)9例;治愈率61.5％,病死率38.5％,其中MDRAB治愈率100％,XDRAB病死率55.6％.结论神经外科ICU耐药鲍曼不动杆菌颅内感染病死率高,切口脑脊液漏和脑室外引流是主要的感染原因,脑脊液引流通畅和合理选择抗生素是成功治愈的关键,MDRAB基于美罗培南的联合治疗和XDRAB基于多粘菌素或替加环素联合舒巴坦钠的治疗能提高治愈率.
목적 탐토신경외과ICU내약포만불동간균로내감염적치료방안.방법 대남방의과대학남방의원신경외과중증감호병방(NSICU)수치적포만불동간균로내감염13례적림상자료진행회고성분석,포괄일반정황、원발질병、감염부위、감염원인、약물민감성、치료방안급치료결과.결과 13례균위내약포만불동간균감염,뇌막염4례,뇌실염9례;감염원인:뇌척액절구루7례,뇌실외인류3례,혈류감염역행2례,요대지인류1례;다중내약(MDRAB)4례,범내약(XDRAB)9례;치유솔61.5％,병사솔38.5％,기중MDRAB치유솔100％,XDRAB병사솔55.6％.결론 신경외과ICU내약포만불동간균로내감염병사솔고,절구뇌척액루화뇌실외인류시주요적감염원인,뇌척액인류통창화합리선택항생소시성공치유적관건,MDRAB기우미라배남적연합치료화XDRAB기우다점균소혹체가배소연합서파탄납적치료능제고치유솔.
Objective To explore the treatment of intracranial infection due to drug-resistant Acinetobacter Baumannii in neurosurgical ICU.Methods The clinical data,including general status,primary diseases,infection sites,infection causes,drug sensitivity,therapeutic strategies and therapeutic effects,of 13 cases of intracranial infection due to drug-resistant Acinetobacter Baumannii in neurosurgical ICU (NSICU) of our hospital were retrospectively analyzed.Results The 13 cases,including 4 cascs of meningitis and 9 cases of ventriculitis,were all infected by drug-resistant Acinetobacter Baumannii.The causes of infection included 7 cases of CSF leakage,3 external ventricular drainage,2 retrograde hematogenous infection,and 1 lumbar cistern drainage.There were 4 cases of multi-drug resistant Acinetobacter Baumannii (MDRAB) and 9 cases of extensively drug resistant Acinetobacter Baumannii (XDRAB).The curative rate and mortality rate was 61.5％ and 38.5％,respectively.The curative rate of MDRAB was 100％,while the mortality rate of XDRAB was 55.6％.Conclusions The mortality rate of intracranial infection due to drug-resistant Acinetobacter Baumannii in NSICU was high.The main causes of infection were CSF leakage of incision and external ventricular drainage.Effective CSF drainage and reasonable choice of antibiotics were the keypoints for successful treatment.Combined treatment based on Meropenem for MDRAB,and treatment based on Polymyxin or Tigecycline combined with Sulbactam sodium for XDRAB could raise the curative rate.