神经外科患者脑脊液病原菌分布及耐药性变迁

目的了解北京天坛医院神经外科患者脑脊液分离病原菌及其耐药趋势变化情况。方法对1997年8月—2013年8月该院神经外科患者脑脊液标本分离的病原菌情况及其药敏结果进行分析。结果共分离病原菌2 732株,其中革兰阳性(G+)菌1 946株(71.23%),革兰阴性(G-)菌786株(28.77%)。居前3位的病原菌分别为葡萄球菌属(1 751株,64.09%)、不动杆菌属(254株,9.30%)和肠球菌属(172株,6.30%)。G+菌仍占主体,其中耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为74.34%和80.73%;但近年G-菌逐渐增多。所有葡萄球菌属对万古霉素、利奈唑胺保持较高敏感性(90%);G-菌总体敏感率下降,尤其不动杆菌属对亚胺培南及美罗培南的敏感率分别为51%、44%。结论神外患者颅内感染仍以G+菌多见,MRSA和MRCNS检出率高;但近年,G-菌,尤其是泛耐药的不动杆菌属所占比例呈上升趋势。

Distribution and drug resistance change of bacteria isolated from cerebrospinal fluid of neurosurgery patients

ObjectiveTo investigate the isolation and drug resistance change trend of pathogens isolated from cerebrospinal fluid (CSF) of neurosurgical patients in Beijing Tian Tan Hospital. MethodsPathogens and antimicrobial susceptibility of pathogens from CSF specimens of neurosurgical patients from August 1997 to August 2013 were analyzed. ResultsA total of 2 732 isolates of pathogens were detected,gram positive  and gram negative  bacteria accounted for 71.23%(n=1 946 ) and 28.77%(n=786 ) respectively. The top three isolated bacteria were Staphylococcus spp. (n=1 751,64.09%), Acinetobacter spp. (n=254, 9.30%), and Enterococcus spp. (n= 172, 6.30%). Gram positive bacteria were the major isolated pathogens, detection rate of methicillin resistant Staphylococcus aureus (MRSA) and methicillin resistant coagulase negative Staphylococcus (MRCNS) was 74.34% and 80.73% respectively; gram negative bacteria increased gradually in recent years. All Staphylococcus spp.  isolates were highly sensitive to vancomycin and linezolid（＞90%） . The overall antimicrobial susceptibility rate of gram negative bacteria decreased, susceptibility rates of Acinetobacter spp. to imipenem and meropenem was 51% and  44% respectively. ConclusionThe major pathogens causing intracranial infection in neurosurgical patients are gram positive bacteria, the detection rates of MRSA and MRCNS are high; gram negative bacteria, especially extensively drug resistant Acinetobacter spp. shows an increasing tendency in recent years.