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目的研究成人中枢神经系统感染患者脑脊液病原菌特征及患者预后,为该类疾病的临床治疗提供依据。方法回顾性分析2014年1月到2016年9月在四川大学华西医院脑脊液培养阳性的中枢神经系统感染患者的临床特征和实验室检查结果。对患者脑脊液分离病原菌的菌种分布和耐药性进行分析,并对菌种特征与住院患者死亡的关系进行分析。结果共纳入157例病例,包括社区获得性感染87例(55.4%)和医院获得性感染70例(44.6%)。从患者脑脊液标本中共分离出病原菌158株,其中革兰阴性菌73株(46.2%)、真菌64株(40.5%)和革兰阳性菌21株(13.3%)。从菌种分布看,社区获得性感染患者分离菌种以新生隐球菌最多(62/87,71.3%),而医院获得性感染患者以鲍曼/醋酸钙不动杆菌复合体最多(31/71,43.7%)。耐药表型分析结果显示新生隐球菌对抗真菌药物均敏感,鲍曼/醋酸钙不动杆菌复合体对常规治疗药物的耐药率≥90.0%,肺炎克雷伯菌对常规治疗药物的耐药率≤25.0%。革兰阴性菌组、真菌组和革兰阳性菌组的住院死亡率分别为52.3%(38/72)、32.8%(21/64)和19.0%(4/21),三组间差异具有统计学意义(P=0.006),革兰阴性菌组患者死亡率较高。结论我院社区获得性中枢神经系统感染患者脑脊液分离的常见病原菌是新生隐球菌,医院获得性感染患者脑脊液分离常见病原菌是革兰阴性杆菌。革兰阴性菌感染患者死亡率较高。
Objective To study the characteristics of cerebrospinal fluid pathogens and the prognosis of patients with central nervous system infection in adults and provide the basis for the clinical treatment of such diseases. Methods The clinical features and laboratory findings of cerebrospinal fluid positive CNS infection in West China Hospital of Sichuan University from January 2014 to September 2016 were retrospectively analyzed. The distribution and drug resistance of pathogens isolated from cerebrospinal fluid of patients were analyzed, and the relationship between the characteristics of strains and the death of hospitalized patients was analyzed. Results A total of 157 cases were enrolled, including 87 community-acquired infections (55.4%) and 70 (44.6%) hospital-acquired infections. A total of 158 pathogenic bacteria were isolated from cerebrospinal fluid of patients, including 73 (46.2%) Gram-negative bacteria, 64 (40.5%) fungi and 21 (13.3%) Gram-positive bacteria. According to the distribution of bacteria, Cryptococcus neoformans was the most isolated (62/87, 71.3%) in community-acquired infections patients, whereas Acinetobacter baumannii complex was the most frequently hospital-acquired infection (31/71 , 43.7%). Drug resistance phenotype analysis showed that C. neoformans were all sensitive to antifungal agents, and the drug resistance rate of Acinetobacter baumannii / Acinetobacter calcoacetic complex was more than or equal to 90.0%, and Klebsiella pneumoniae was resistant to conventional drugs Rate ≤ 25.0%. The in-hospital mortality of Gram-negative bacteria group, fungal group and Gram-positive bacteria group were 52.3% (38/72), 32.8% (21/64) and 19.0% (4/21), respectively Significance of learning (P = 0.006), Gram-negative bacteria in patients with higher mortality. Conclusions The common pathogen of cerebrospinal fluid separation in patients with community-acquired CNS infection in our hospital is Cryptococcus neoformans. Gram-negative bacilli are common pathogens in cerebrospinal fluid separation in hospital-acquired infections. Gram-negative bacterial infections in patients with higher mortality.