目的 分析经鼻蝶入路行垂体腺瘤切除术(TSPA)后脑膜炎和/或菌血症的发生率、致病菌、抗菌谱及疗效.方法 回顾性分析2012年1月至2016年12月,北京协和医院神经外科TSPA术后经微生物学和临床证实为脑膜炎和/或菌血症的临床及病原学资料.结果 TSPA术后脑膜炎和/或菌血症的发病率为1.2%(59/5098),27例为脑膜炎,26例为菌血症,6例为脑膜炎合并菌血症.脑脊液培养检出致病菌41株,革兰阳性菌27株(65.9%),最常见为凝固酶阴性葡萄球菌(14株);血培养共检出病原菌34株,革兰阴性菌为主(25株,73.5%),常见为肺炎克雷伯菌(9株)、产气肠杆菌(7株)和大肠埃希菌(5株).这些致病菌均对阿米卡星、亚胺培南和美罗培南敏感.本组59例经抗生素治疗后治愈52例,死亡7例,其中脑膜炎患者病死率明显高于菌血症患者(21.2%vs 3.1%,P<0.001).结论 TSPA术后有出现脑膜炎和/或菌血症的可能,两者的常见致病菌、耐药菌比例和预后均不同,应根据药敏结果合理治疗.%Objective To evaluate the incidence and microbiology profile of infectious complications ( namely menin-gitis and/or bacteremia ) after trans-sphenoidal pituitary adenomectomies ( TSPA ) .Methods All hospitalized patients undergoing TSPA in Dept .Neurosurgery of Peking Union Medical College Hospital ( PUMC) between January 2012 and December 2016 were retrospective recorded .Results The incidence of postoperative meningitis and/or bacteremia was 1.2%( 59/5098) .27 cases of meningitis were documented for a total of 41 isolates, 26 cases of bacteremia for 34 isolates, and 6 cases of coinfection.Gram-positive organisms predominated (27 cases, 65.9%) in meningitis, among which Coagulase-negative staphylococci were the main isolates (14 cases).The most common organisms causing bacteremia were Gram-negative organisms (25 case,73.5%),including Klebsiella pneu-monia ( 9 cases ) , Enterobacter aerogenes ( 7 cases ) and Escherichia coli ( 5 cases ) , all of which were sensitive to amikacin, imipenem and meropenem .Fifty-two patients were cured after antibiotic treatment , whereas 7 died.The morality in patients with meningitis was relatively lower than those with bacteremia (21.2%vs 3.1%,P<0.001). Conclusions Postoperative meningitis and/or bacteremia can occur after TSPA .They differ in etiology profile and prognosis , and should be treated with proper antibiotics according to the drug resistance .
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