替加环素联合头孢哌酮/舒巴坦治疗耐药鲍曼不动杆菌颅内感染临床研究

目的探讨替加环素联合头孢哌酮/舒巴坦治疗耐药鲍曼不动杆菌（DRAB）颅内感染的临床疗效及安全性。方法回顾性分析2014年1月-2015年4月某院脑脊液病神经外科收治的12例DRAB颅内感染患者，评价替加环素联合头孢哌酮/舒巴坦治疗DRAB颅内感染患者的临床疗效及安全性。结果替加环素联合头孢哌酮/舒巴坦抗感染治疗12～62 d（平均39.5 d），大多数患者临床症状、体征（包括体温、脑膜刺激征）等较治疗前均有明显改善，其中痊愈3例，显效5例，放弃或无效（死亡）4例。临床总有效率为66.67%（8/12），病死率33.33%（4/12），脑脊液细菌清除率为83.33%（10/12）。死亡原因：2例因脑外伤后脑干衰竭，1例因脑实质广泛感染，1例因治疗有效后停药致颅内感染复发、脑脓肿形成。治疗期间未发生明显不良反应。结论在保持脑脊液引流通畅的前提下，替加环素联合头孢哌酮/舒巴坦长程治疗能有效清除脑脊液DRAB，且具有良好的安全性。

Clinical study of tigecycline combined with cefoperazone/sulbactam for treatment of intracranial infection with drug resistant Acinetobacter baumannii

ObjectiveTo evaluate clinic efficacy and safety of tigecycline combined with cefoperazone/sulbactam for treatment of intracranial infection with drug resistant Acinetobacter baumannii(DRAB).Methods12 patients with DRAB intracranial infection admitted in a department of neurosurgery between January 2014 and April 2015 were analyzed retrospectively, clinic efficacy and safety of tigecycline combined with cefoperazone/sulbactam for treatment of DRAB intracranial infection were evaluated. ResultsAfter patients received tigecycline combined with cefoperazone/sulbactam for 12 62 days（39.5 days on average）, clinical symptoms and signs（including body temperature, signs of meningeal irritation）of most patients were significantly improved compared with before treatment，3 cases were cured, 5 were markedly effective, 4 abandoned or ineffective(death). The overall effective rate was 66.67%（8/12），mortality was 33.33%（4/12）；bacterial clearance rate of cerebrospinal fluid (CSF) was 83.33%(10/12). Causes of death: 2 were with failure of brain stem following craniocerebral trauma，1was extensive parenchymal infection，1was recurrence of intracranial infection and formation of brain abscess after withdrawing antimicrobial agents. No significant adverse reaction occurred during the treatment period. ConclusionOn the basis of keeping CSF drainage unobstructed, long course treatment of tigecycline combined with cefoperazone/sulbactam can effectively eliminate DRAB from CSF, and has a good safety.