氟胞嘧啶 两性霉素B脂质体 伊曲康唑联合治疗隐球菌性脑膜炎80例临床分析

目的观察氟胞嘧啶、两性霉素B脂质体、伊曲康唑联合治疗隐球菌性脑膜炎中的临床效果。方法 80例隐球菌性脑膜炎患者随机分为对照组和观察组,对照组采用两性霉素B脂质体+氟康唑+氟胞嘧啶治疗,观察组采用两性霉素B脂质体+伊曲康唑+氟胞嘧啶治疗。比较2组治疗效果及治疗前后脑脊液压力、生化改善情况,观察治疗前后脑脊液真菌培养阳性率改善情况。结果观察组总有效率达85%,显著高于对照组的65%(P0.05)。观察组治疗后脑脊液压力、脑脊液蛋白显著低于对照组(P0.05)。观察组治疗后脑脊液真菌培养阳性率显著低于对照组(P0.05)。结论采用氟胞嘧啶、两性霉素B脂质体、伊曲康唑联合治疗隐球菌性脑膜炎,临床效果优于低剂量两性霉素+氟康唑+氟胞嘧啶组,脑脊液培养、脑脊液生化结果改善更显著。     

广西北部湾地区成人化脓性脑膜炎脑脊液培养的病原菌分析

目的探讨广西北部湾地区成人化脓性脑膜炎脑脊液培养的病原菌分布及其对抗菌药物的敏感性。方法回顾分析2015-01-2017-06钦州市第一人民医院收治的51例化脓性脑膜炎患者的脑脊液涂片及培养结果,并分析病原菌的药物敏感性。结果 51株病原菌,以真菌感染的新型隐球菌为主,共28株,革兰阴性杆菌6株,脑膜炎奈瑟菌1株。革兰阳性球菌12株,革兰阳性球菌中以链球菌为主。在培养出的真菌中,均对氟康唑、伏立康唑、伊曲康唑、两性霉素B、氟胞嘧啶敏感。结论广西北部湾地区成人化脓性脑膜炎病原菌以新型隐球菌为主。     

神经外科重症监护室肺炎克雷伯菌随机扩增多态性DNA分子流行病学研究

目的 采用随机扩增多态性DNA(RAPD)基因分型方法 监测肺炎克雷伯菌医院感染情况. 方法 对我院神经外科重症监护室临床分离的72株肺炎克雷伯菌进行RAPD基因分型,并通过指纹图谱比较分析,确证医院感染爆发. 结果 72株肺炎克雷伯菌共分得68型,未发生肺炎克雷伯菌医院感染局部流行. 结论 RAID基因分型方法 可对肺炎克雷伯菌进行分子流行病学调查.     

新型隐球菌性脑膜炎26例临床观察

目的观察新型隐球菌性脑膜炎的临床特点,总结分析其临床表现、实验室检查、鉴别诊断与治疗原则,探讨新型隐球菌性脑膜炎治疗进展。方法对26例新型隐球菌性脑膜炎患者的临床资料进行回顾,总结其治疗经验。结果所有患者均表现为头痛、发热,脑脊液乳胶凝集试验阳性,其中21例脑脊液墨汁染色可见新型隐球菌生长。经两性霉素B联合氟胞嘧啶、氟康唑治疗,总有效率达76.92%(20/26);4例早期采用两性霉素B联合伏立康唑治疗的患者症状与体征明显改善。结论新型隐球菌性脑膜炎误诊率高,脑脊液乳胶凝集试验阳性有助于早期明确诊断,可减少误诊率。两性霉素B、氟胞嘧啶、氟康唑均为一线抗真菌药物,联合用药可提高疗效。     

神经外科重症监护室铜绿假单胞菌基因分型和耐药性研究

目的 建立随机扩增多态性DNA（RAPD）基因分型方法监测神经外科重症监护室（ICU）铜绿假单胞菌（PA）医院感染并进行耐药性分析。方法 收集自2004年至2005年ICU内分离出的75株PA，提取DNA后进行RAPD分型，同时进行抗生素敏感性实验。结果 75株PA共得14型，其中有3株属于同一种类型；抗生素敏感性实验表明PA对氨基糖苷类和环丙沙星等耐药率呈明显上升趋势，75株均为对亚胺培南／西司他丁，头孢哌酮／舒巴坦等少数几种敏感的多重耐药株。结论 ICU内存在PA感染爆发流行；了解PA的耐药现状，有利于为临床合理用药提供依据。     

利奈唑胺治疗肾移植后重症肺部感染30例

为评价利奈唑胺对肾移植患者重症肺部感染的疗效与安全性,对30例肾移植后重症肺部感染患者应用利奈唑胺治疗的临床资料进行回顾性分析。根据临床症状初步判断病原菌,采取经验性降阶梯治疗,联合给予抗细菌、抗病毒和抗真菌治疗,抗生素均采用利奈唑胺300 mg 静滴,2次/d,结合抗杆菌类药物常用的有氨曲南、头孢吡肟、亚胺培南,更昔洛韦抑制巨细胞病毒感染,抗真菌感染应用氟康唑、伊曲康唑、伏立康唑、卡泊芬净、米卡芬净,复方新诺明抗肺孢子虫四联治疗。1例病情严重给予气管插管机械通气辅助呼吸,3 d后死亡外,其余29例患者经积治疗痊愈,其中4例并发急性呼吸窘迫综合征,治愈率达97%,利奈唑胺治疗有效率97%,细菌清除率为91%,未发现与药物相关不良反应导致停止治疗的记录。提示利奈唑胺是治疗肾移植患者重症肺部感染安全有效的药物。     

新型隐球菌脑膜炎的治疗

新型隐球菌脑膜炎死亡率和复发率高,治疗困难.随着5-氟胞嘧啶与二性霉素B诱导期的联合应用,使二性霉素B的使用时间缩短,减少了药物的毒副反应;氟康唑、伊曲康唑巩固期及维持期的应用使复发率降低;通过联合二性霉素B鞘内或侧脑室内注入,提高了救治成功率;对颅高压的妥善处理降低了死亡率;单克隆抗体及高活性抗逆转录病毒药物的应用,进一步提高了疗效,降低了复发率.真菌疫苗在实验动物模型中获得的成功,为临床的免疫接种打下了基础.     

新型隐球菌对抗真菌药的耐药性观察

目的检测新型隐球菌对3种抗真菌药的敏感性及其耐药状况。方法应用E-test试条，分别对新型隐球菌A、B、C、D及AD型标准菌株，以及从隐球菌性脑膜炎患者的脑脊液(CSF)中分离出的新型隐球菌36株进行药理检测。结果标准菌株对两性霉素B敏感的为A、C、D型，依赖性敏感的为B型，耐药的为AD型；对氟胞嘧啶均为依赖性敏感；对氟康唑依赖性敏感的为B、D型，耐药的为A、C、AD型。从病例CSF分离出的36份标本中，新型隐球菌A型占86％(31／36)，D型占8％(3／36)，AD型占6％(2／36)。对两性霉素B敏感、依赖性敏感和耐药分别为80％、14％和6％；对氟胞嘧啶敏感、依赖性敏感和耐药分别为28％、69％和3％；对氟康唑敏感、依赖性敏感和耐药分别为53％、33％和14％。结论新型隐球菌药敏试验对临床药物的选择有重要的指导作用。     

音乐护理在神经外科重症监护室的应用与效果评价

目的探讨音乐护理在神经外科重症监护室的应用效果。方法尝试在神经外科重症监护室,每天集中3个时间段(8∶30、16∶30、20∶30)播放舒缓、轻柔的背景音乐,每次播放1.5～2h。采用自行设计的问卷分别调查12名神经外科重症监护室护士和65名患者对采用音乐护理的评价;对音乐护理前后护理质量的评价。结果 (1)100%的护士和95.3%的患者对音乐护理创造温馨、舒心、和谐的外部环境给予认同,91.6%的护士和95.3%的患者赞同实行音乐护理;96.9%的患者对神经外科重症监护室的护理综合服务评价满意。(2)音乐护理前后护理质量评价:神经外科重症监护室基础护理合格率由2010年度的92.1%提升至2011年度的97.3%,护理综合质量评价合格率有2010年度的93.4%提升至98.7%。结论音乐护理有助于营造温馨、舒心、和谐的环境,对提升综合护理质量有很大帮助。     

颅脑术后颅内感染42例病原学分析与治疗体会

目的探讨颅脑术后颅内感染的病因和治疗策略。方法对2007-09-2011-07我科收治的42例颅脑术后颅内感染患者脑脊液和（或）脑脓肿液中分离出的致病菌及其药物敏感性和治疗进行分析。结果引起颅内感染的致病菌中革兰阳性菌占64.36%（65株）,革兰阴性菌占33.66%（34株）,真菌占1.98%（2株）。对革兰阳性菌敏感的抗生素有头孢噻肟钠、万古霉素和利奈唑胺等;对革兰阴性菌敏感的抗生素有美罗培南、头孢哌酮舒巴坦钠等;对白色念珠菌敏感的抗生素有氟康唑等。结论颅脑术后颅内感染仍以革兰阳性菌为主,治疗应以静脉和鞘内联合应用抗生素为主。     

肝移植术后早期深部真菌感染诊治分析

为探索肝移植后早期深部真菌感染的早期诊断和治疗措施,收集了重庆医科大学附属第一医院重庆市器官移植中心2001-10/2008-10的72例肝移植患者移植后并发早期深部真菌感染16例患者的临床资料,分别对其易感因素、病原学特点、诊断方法、治疗方案及预防措施进行回顾性病例分析。16例肝移植患者发生早期深部真菌感染23例次,死亡4例,感染发生率22.2%(16/72),死亡率25.0%(4/16)。肺部感染15例次,肠道感染6例次,胆道感染1例次,颅内感染1例次。白色念珠菌感染占65.22%,非白色念珠菌感染占17.39%,曲霉菌感染占13.04%,隐球菌感染占4.35%。发病时间为移植后5~26 d。可见早期深部真菌感染是影响肝移植患者后生存率的重要原因之一。有效预防、早期诊断和积极治疗是提高深部真菌感染治愈率的关键。     

Successful treatment of Candida meningitis with miconazole

This paper presents a case of successful treatment of candida meningitis with miconazole. A 55-year-old woman was admitted due to high fever, vomiting and urinary incontinence on November 11, 1986. Four months prior to this episode, she had been treated for a ruptured aneurysm with neck-clipping and V-P shunt for NPH. Candida albicans was cultured from her CSF. The shunt system was immediately removed and an Ommaya's reservoir was installed for external drainage and intrathecal administrations. Combination therapy (amphotericin B and flucytosine) was initiated. However, it was discontinued after ten days because of high fever and chills after intrathecal injection of amphotericin B. Treatment with miconazole intrathecally (10-90 mg/week, total 565 mg) and intravenously (200-1200 mg/day, total 70.4 g) was begun on November 23. Clinical and CSF findings were improved soon. No side effect of miconazole was observed. After V-P shunt revision, she was discharged without neurological deficit on March 12, 1987. Reports of mycosis in central nervous system are recently increasing, especially for candidosis. Cryptococcosis is noted frequently as an opportunistic infection of AIDS. The administration of amphotericin B and flucytosine has been the main therapy for mycotic meningitis. Unfortunately, however, Amphotericin B has many toxic effects, including renal dysfunction, and flucytosine can induce the emergent resistance. Miconazole has been used to successfully treat cryptococcosis, aspergillosis or coccidiosis, and was effective in our case of candida meningitis. Few side effects have been reported with its use. The intrathecal injection of miconazole is recommended for meningitis, because the drug is taken up minimally into CSF space after intravenous administration.(ABSTRACT TRUNCATED AT 250 WORDS)     

神经外科重症监护病房细菌流行及耐药性的20年监测

目的探讨神经外科重症监护病房(NSICU)医院获得性细菌感染的病原菌及其耐药情况的流行病学特点,指导临床诊疗。方法收集1995年1月~2014年11月北京天坛医院NSICU所有细菌分离株及药敏结果,统计分析其流行病学特点及耐药性变迁。比较2014年1~11月病房总体分离细菌与颅内感染分离细菌的分布及耐药性。结果 NSICU病房分离细菌5409株,其中痰标本91.57%、脑脊液3.85%、其他4.58%;革兰氏阴性菌3987株,革兰氏阳性菌1422株;排前5位的分别是铜绿假单胞菌1340株、不动杆菌属1330株、金黄色葡萄球菌1122株、克雷伯菌属588株、凝固酶阴性葡萄球菌209株。其中2007年1月~2014年11月颅内感染分离菌株革兰阴性菌66株,格兰阳性菌60株。革兰氏阴性菌感染中常见的不动杆菌属及铜绿假单胞菌大部分对常见的抗菌药包括碳青霉烯类抗生素广泛耐药,但颅内感染分离菌株对头孢唑肟及磺胺类敏感;革兰氏阳性菌感染中多见的葡萄球菌属对万古霉素依旧保持较高的敏感率。结论 NSICU的院内获得性感染中以肺部感染为主,致病菌主要为革兰氏阴性菌,广泛耐药的不动杆菌属及铜绿假单胞菌明显增多。而NSICU内的颅内感染的致病菌革兰阴性菌与阳性菌比例差别不大,且其耐药率与病房分离总体一致,但不动杆菌属对头孢唑肟及磺胺类敏感。     

Méningomyéloradiculite à Candida albicans chez un sujet immunocompétent

IntroductionCandida infection limited to the central nervous system is extremely rare, and may be confused with tuberculosis on the grounds of the clinical and cerebrospinal fluid findings.Case reportA 23-year-old immunocompetent drug addict presented with alternating sciatica over a period of several months, followed by multiple cranial nerve involvement in the setting of marked weight loss. The histopathologic examination of a leptomeningeal neurosurgical biopsy was required to establish the diagnosis of neuromeningeal infection with Candida albicans.ConclusionThis case report underlines diagnostic difficulties of candidal meningitis and reviews current therapeutic recommendations.     

幽门螺杆菌细胞毒素相关蛋白A在脑梗死中的作用

目的探讨幽门螺杆菌细胞毒素相关蛋白A(Cag-A)与脑梗死发生的关系。方法使用酶联免疫法测定100名患者和50名健康对照者Cag-A抗体,并对脑梗死患者检测CagA-HP-IgG阳性及阴性情况下颈动脉斑块和脑梗死相关因素水平。结果脑梗死组血清CagA-HP-IgG阳性率为62%,而对照组为38%,两组相比有显著性差异(P<0.05)。脑梗死组CagA-HP-IgG阳性100%存在颈动脉斑块;而CagA-HP-IgG阴性者仅55%存在颈动脉斑块,两者之间存在显著性差异(P<0.05)。CagA-HP-IgG阳性的脑梗死患者CRP水平及血纤维蛋白原水平均显著高于CagA-HP-IgG阴性者(P<0.05)。结论Cag-A阳性菌株感染与脑梗死的发生有关,是其发病的危险因素。     

Antimicrobial activity of Substance P and Neuropeptide Y against laboratory strains of bacteria and oral microorganisms

Infection and inflammation of mucosal tissue may induce the production of neuropeptides, specifically Substance P and Neuropeptide Y. Since these neuropeptides are similar to antimicrobial peptides in their amino acid composition, amphipathic design, cationic charge, and size, we wanted to determine if they had antimicrobial activity against a panel of common bacteria and oral microorganisms using the radial diffusion assay. Neuropeptide Y and Substance P had antimicrobial activity against E. coli (MIC 20.6+/-5.5 microg/ml SEM and 71.5+/-15 SEM microg/ml, respectively), but did not have activity against laboratory strains of Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Serratia marcescens (MIC>500 microg/ml) nor oral strains of Streptococcus mutans, Candida albicans, and Actinobacillus actinomycetemcomitans (MIC>500 microg/ml). While Substance P and Neuropeptide Y did not have direct antimicrobial activity against the microorganisms tested, they still may stimulate local epithelial cells to produce other innate immune factors like defensins and cathelicidins. However, this remains to be determined.     

Inefficient T cell memory in the brain of mice infected with Candida albicans

We compared the contribution of T cell memory to the clearance of the fungus Candida albicans from the liver, kidneys and brain of Balb/c mice in a model of secondary systemic infection. In secondary infection, the fungi were more rapidly eliminated from the liver and kidneys than during primary infection. This was most pronounced in the liver where the fungi were eliminated at day 14 of infection. In contrast, in the brain, cultivable yeasts were still detectable 35 days after infection. Although both CD4(+) and CD8(+) cells could be detected in the brain with immunohistology, these cells appeared later in infection and in lower numbers than in the liver, and there were no significant differences in the numbers of T cells detected in the brain between primary and secondary infection. In contrast to the liver and the kidneys where an effect of T cells on the fungal load could be demonstrated, depletion of neither CD4(+) nor CD8(+) nor Thy-1.2(+) cells resulted in a significant increase of the amount of fungi in the brain above levels measured in secondarily infected mice treated with irrelevant antibodies. We conclude that the contribution of CD4(+) and CD8(+) cells to the clearance of C. albicans in secondary infection is organ-dependent and that T cell memory is inefficient in the brain.