CAJ | 학술논문

目的：分析神经外科颅内感染患者脑脊液中细菌分布及抗生素敏感率的变化情况，为经验选用抗生素提供依据。方法查找、收集2012年1月-2014年12月山西医科大学第一医院神经外科行外科干预后发生颅内感染且脑脊液细菌培养阳性患者的相关数据，回顾性分析脑脊液病原菌分布及抗生素敏感率，逐年对比病原菌分布及药物敏感率变化，以SPSS17.0软件进行分析。结果脑脊液分离菌株75株，包括革兰阳性菌51株(68%)，主要为凝固酶阴性葡萄球菌，对万古霉素、利奈唑胺全部敏感；革兰阴性菌21株(32%)，三年间构成比依次为13%、32%、48.1%，明显呈逐年增多趋势(P<0.05)，包括肺炎克雷伯杆菌14株，鲍曼不动杆菌4株，其中肺炎克雷伯杆菌抗生素敏感率低，鲍曼不动杆菌呈泛耐药状态。结论外科干预后发生颅内感染中革兰氏阳性菌仍占主要部分，但革兰氏阴性菌构成比呈逐年上升趋势，在经验使用抗生素时，应注意联合用药，防止患者耐药性的增加以及自身菌群失调，降低患者不良预后的风险。
목적：분석신경외과로내감염환자뇌척액중세균분포급항생소민감솔적변화정황，위경험선용항생소제공의거。방법사조、수집2012년1월-2014년12월산서의과대학제일의원신경외과행외과간예후발생로내감염차뇌척액세균배양양성환자적상관수거，회고성분석뇌척액병원균분포급항생소민감솔，축년대비병원균분포급약물민감솔변화，이SPSS17.0연건진행분석。결과뇌척액분리균주75주，포괄혁란양성균51주(68%)，주요위응고매음성포도구균，대만고매소、리내서알전부민감；혁란음성균21주(32%)，삼년간구성비의차위13%、32%、48.1%，명현정축년증다추세(P<0.05)，포괄폐염극뢰백간균14주，포만불동간균4주，기중폐염극뢰백간균항생소민감솔저，포만불동간균정범내약상태。결론외과간예후발생로내감염중혁란씨양성균잉점주요부분，단혁란씨음성균구성비정축년상승추세，재경험사용항생소시，응주의연합용약，방지환자내약성적증가이급자신균군실조，강저환자불량예후적풍험。
Objective To analyze the bacterial distribution in the cerebrospinal fluid of patients with nosocomial intracranial infec-tion and the changes of their antibiotic sensitivity, in order to provide reference for experienced application of antibiotics. Methods The data of patients who got intracranial infection after surgical intervention during January 2012 and December 2014 in the De-partment of Neurosurgery of The First Hospital of Shanxi Medical University and the result of bacterial culture of whose cere-brospinal fluid was positive were selected, and the bacterial distribution in the cerebrospinal fluid and the changes of their antibi-otic sensitivity were analyzed retrospectively and compared year by year by SPSS15.0 software. Results 75 pathogens were isolated from cerebrospinal fluid, including 51(68%) gram-positive bacteria, mainly coagulase-negative staphylococci which was completely sensitive to vancomycin, linezolid and 21 (32%) gram-negative bacteria, the constituent ratio of which within 3 year were 13%, 32%, 48.1% in turn showing an obvious increasing trend year by year (P<0.05), and which contained 14 klebsiella pneumoniae with antibiotic sensitivity and 4 acinetobacter baumannii with pan-drag resistance. Conclusion In intracranial infection after surgi-cal intervention, gram-positive bacteria was the main pathogenic bacteria, but constituent ratio of the gram-negative bacteria shows an obvious increasing trend. In the experienced application of antibiotics, combined medication should be emphasized to control the drug resistance of patients and avoid the flora imbalance, as well as lower the possibility of poor prognosis.