颅脑术后表皮葡萄球菌性脑膜炎的临床分析

目的 分析颅脑术后表皮葡萄球菌性脑膜炎的临床表现、危险因素、细菌耐药性特点,探讨预防措施及治疗方法.方法 回顾性收集1999年8月至2007年8月山东大学齐鲁医院神经外科颅脑术后脑脊液培养证实表皮葡萄球菌生长患者的资料进行统计学分析.结果 6887例颅脑手术患者,术后发生表皮葡萄球菌感染27例,男16例,女11例;年龄2~72岁,平均37.5岁.颅内肿瘤手术4660例,术后感染10例;脑外伤手术787例,术后感染5例;颅内置管性手术577例,术后感染10例(脑室体外引流和脑脊液分流,其中2例为合并脑肿瘤患者);颅内其他手术863例,术后感染4例,其发生率分别为0.21%、0.64%、1.73%、0.46%.置管性手术组与其他手术组相比差异有统计学意义(P<0.05).耐甲氧西林表皮葡萄球菌总体检出率为70.4%,未有耐万古霉素菌株出现.结论 表皮葡萄球菌是颅脑术后颅内感染的主要病原菌,且耐药性逐年增强.其感染好发于颅内置管性手术及污染手术,万古霉素是治疗的首选药物.术前预防性用药疗效不确切,严格无菌术是重要预防措施.

Clinical analysis of staphylococcic epidermidis infections after craniotomy

Objectives To investigate the clinical manifestations, risk factors, bacterial resistance to drugs, so the prophylactic measures and therapy for staphylococcic epidermidis meningitis associated with post-neurosurgical patients maybe defined. Methods A retrospective study of the patients, who were performed neurosurgical operations between August 1999 and August 2007 in Qilu Hospital of Shandong University, was made. Staphylococcus epidermidis was cultured from the cerebrospinal fluid of all cases. Results There were 27 positive patients in the series of 6887 operations, containing 16 males and 11 females, age 2-72y, mean age 37.5y. 10 out of 4660 patients for intracranial tumors, 5 out of 787 for craniocerebral trauma, 10 out of 577 for cerebrospinal fluid shunt or external ventrical drainage (2 complicating intracranial tumors), and 4 for other kinds of operations out of 863 patients. The morbidity of infection was 0.21%, 0.64%, 1.73%, and 0.46% respectively, which had significant difference between the third and the others (P<0.05). The general isolating rate of the methicilin resistant staphylococcus epidermidis was 70.4%. All of the cases were sensitive to vancomycin. Conclusions The staphylococcus epidermidis is one of the most important pathogenic bacterias causing postoperative meningitis, which has predilection in patients with cerebrospinal fluid shunt and external ventrical drainage or with contaminated injuries. Though all sensitive to vancomycin, the isolating rate of the methicilin resistant staphylococcus epidermidis is increasing year by year making vancomycin the first choice to cure. Prophylactic antibiotics may be helpful, while rigorous aseptic technique is an important measure to prevent meningitis caused by staphylococcus epidermidis.