神经外科患者脑脊液细菌流行病学和耐药性监测

目的监测神经外科患者脑脊液致病菌流行病学分布及耐药状况。方法收集北京天坛医院神经外科2000年1月～2004年12月，送检脑脊液标本中分离的致病菌及药敏鉴定结果，统计致病菌分布和抗菌药物敏感率。结果分离到致病菌438株，其中革兰阳性球菌316株，占72．1％；革兰阴性杆菌122株，占27．9％；排名前5位的致病菌分别为凝固酶阴性葡萄球菌（53．7％）、金黄色葡萄球菌（10．5％）、肠杆菌属（6．2％）、不动杆菌（6．2％）、铜绿假单胞菌（3．7％）；对革兰阴性菌的总体敏感率为亚胺培南86．9％、哌拉西林／他唑巴坦77．4％、阿米卡星68．0％、头孢吡肟63．9％、头孢他啶63．1％，其余抗菌药物的敏感率均〈60％。结论神经外科患者颅内感染以革兰阳性菌多见，尤其是凝固酶阴性葡萄球菌和金黄色葡萄球菌，本研究结果将为神经外科手术部位感染的预防和经验性抗菌药物治疗提供基本数据资料。

Distribution and Antibiotic Resistance of Bacteria Isolated from Cerebral Spinal Fluid in Neurosurgical Patients: A Surveillance

OBJECTIVE To determine the distribution and antibiotic resistance of bacteria isolated from cerebral spinal fluid in neurosurgical patients. METHODS Bacterial isolates from cerebral spinal fluid specimens in Department of Neurosurgery,Beijing Tiantan Hospital were collected from Jan 2000 to Dec 2004.Distribution and antibiotic resistance of pathogens were analyzed retrospectively. RESULTS Of 438 isolates,Gram positive cocci and Gram negative bacilli accounted for 72.1%(316 isolates) and 27.9%(122 isolates),respectively.The most frequently isolated pathogen was coagulasenegative staphylococci(53.7%) followed by Staphylococcus aureus(10.5%),Enterobacter spp(6.2%),Acinetobacter spp(6.2%),and Pseudomonas aeruginosa(3.7%).The most active compounds against Gram-negative bacilli were imipenem(87% susceptibility),piperacillin/tazobactam(77%),amikacin(68%),cefepime(64%) and ceftazidime(63% susceptibility).Imipenem,cefepime,ceftazidime,and piperacillin/tazobactam demonstrated excellent activity against most of Gram negative bacilli.In S.aureus and coagulase-negative staphylococci,oxacillin resistance strains accounted for 76% and 100%,respectively. CONCLUSIONS Prevailing pathogens are Gram positive cocci in intracranial infection after neurosurgical operation,especially coagulase-negative staphylococci and S.aureus.Data collected in present study will provide valuable information for prophylactic and empirical antibiotic use in post-operative intracranial infection.