神经外科术后患者脑脊液中革兰阳性菌的分布及耐药性分析

目的 了解2011-2015年神经外科术后脑脊液培养阳性患者的革兰阳性菌临床分布情况与耐药性.方法 对2011年1月至2015年12月首都医科大学附属北京天坛医院神经外科术后患者脑脊液培养阳性的革兰阳性菌进行分析,且分别对临床诊断真感染的凝固酶阴性葡萄球菌(CoNS)、金黄色葡萄球菌、粪肠球菌与屎肠球菌的耐药情况进行分析.结果 2011-2015年,神经外科术后分离出革兰阳性菌共1 284株,分离率为4.53％,其中表皮葡萄球菌、人葡萄球菌和金黄色葡萄球菌的分离率最高,依次为38.32％、12.31％和10.75％;共分离出987株CoNS,其中真感染210株(21.28％).药敏试验结果显示,革兰阳性菌对万古霉素、利奈唑胺与替考拉宁敏感度最高均大于90.00％;真感染CoNS对万古霉素与利奈唑胺无法达到100.00％敏感率,对阿米卡星与利福平的敏感率大于90.00％;金黄色葡萄球菌对苯唑西林和四环素耐药率较高,肠球菌对多种药物均有较高耐药率.结论 神经外科术后革兰阳性菌感染问题较为严重,由于CoNS的感染不确定性,以及金黄色葡萄球菌与肠球菌感染的严重性,临床治疗时需特别注意.万古霉素、替考拉宁与利奈唑胺治疗神经外科术后革兰阳性菌感染较有效.

Distribution and drug resistance of gram-positive bacteria isolated from cerebrospinal fluid in patients after neurosurgical operation

Objective To investigate the distribution of species and the change rule of drug resistance of grampositive bacteria isolated from cerebrospinal fluid in patients after neurosurgical operation from January 2011 to December 2015.Methods Gram-positive bacteria were cultured from cerebrospinal fluid and the drug sensitivity test including coagulase-negative staphylococci (CoNS),Staphylococcus aureus,Enterococcusfaecalis and Enterococcus faecium were analyzed on the patients after neurosurgical operation in Beijing Tiantan Hospital,Capital Medical University from 2011 to 2015.Results A total of 1 284 gram-positive bacterial strains were isolated after neurosurgical operation from 2011 to 2015.The isolation rate was 4.53％,of which the top 3 were Staphylococcus epidermidis (38.32％),Staphylococcus hominis (12.31％) and Staphylococcus aureus (10.75％).A total of 987 CoNS strains were isolated,in which there were 210 strains (21.28％) diagnosed as the pathogen in this study.According to antimicrobial susceptibility test,vancomycin,teicoplanin and linezolid were the most effective antibiotics,and the sensitive rates were all higher than 90.00％.CoNS were not 100.00％ sensitive to vancomycin and linezolid and sensitive rates to amikacin and rifampicin were higher than 90.00％.The resistance rates of Staphylococcus aureus to oxacillin and tetracycline were high.Enterococcus was resistant to many common antibiotics.Conclusions The gram-positive bacterial infection after neurosurgical operation is serious.Because of the uncertain infection of CoNS and the severe infections of Staphylococcus aureus and Enterococcus,the clinical treatment should be paid more attention.Vancomycin,teicoplanin and linezolid are the most effective antibiotics for the treatment of gram-positive bacterial infections after neurosurgical operation.