Objective To compare the differences in biochemical and routine manifestations of cerebrospinal fluid (CSF) in critically ill patients with intracranial infection caused by different pathogens in department of neurosurgery. Methods The patients with intracranial infection after neurosurgery were admitted in the department of intensive care unit (ICU) of Beijing Tiantan Hospital, Capital Medical University from January 1, 2013 to December 31, 2016, their examination results of positive CSF samples were obtained, and the differences in biochemical and routine test results among different classes of bacterial pathogens in CSF were compared. Results A total of 404 samples of 310 patients were analyzed; Gram-positive (G+) bacteria were the major cause of infection (308 case-times, 76.2%), among which, Staphylococci epidermidis was the leading causative pathogen (115 cases, 37.3%), followed by coagulase-negative Staphylococci (76 cases, 24.6%), and Staphylococcus aureus (52 cases, 16.9%); bacteria were detected in 96 case-times, accounting for 23.8% and occupying the secondary position. The overall indicator levels of CSF with G- pathogen were higher than those with G+bacteria, among which CSF with G- bacteria pathogen protein content [mg/L: 1 795 (1 999) vs. 1 068 (1 251)], white blood cell (WBC) count [×106/L: 1 069.5 (5 295.8) vs. 446.5 (1 689.3)], proportion of neutrophils [N: 0.877 (0.218) vs. 0.788 (0.416)] were obviously higher than those in CSF with G+bacteria pathogen, however, glucose (Glu) concentration level was lower than that in CSF with positive G- bacteria [mmol/L: 1.7 (2.5) vs. 2.6 (1.7), P < 0.05]. Simultaneously, it was also found that in culture G- bacteria appeared slightly later than G+bacteria [days: 9.0 (10.0) vs. 8.0 (7.0)], Acinetobacter and other negative bacteria being obvious, but as a whole there was no statistical significant difference. Conclusions G+bacteria are the major pathogens for intracranial infections patients after neurosurgery, and its time of isolation in bacterial culture has a tendency of being earlier than that of G- bacteria; in the comparisons between biochemical and routine results of CSF with positive G- bacteria and with positive G+bacteria, there are protein, glucose, WBC and N levels having statistical significant differences, suggesting that these indicators have potential values to differentiate these two kinds of bacteria.%目的 比较神经外科危重症患者颅内感染不同致病菌脑脊液生化及常规检测指标的差异.方法 选择首都医科大学附属北京天坛医院2013年1月1日至2016年12月31日收治的神经外科术后因颅内感染入住重症医学科(ICU)患者的阳性脑脊液标本.比较不同细菌分类之间脑脊液生化、常规检测指标的差异.结果 共收集了310例患者,细菌学阳性脑脊液标本404例次.主要致病菌为革兰阳性(G+)菌(308例次,占76.2%),以表皮葡萄球菌最常见(115例,占37.3%),其次是其他凝固酶阴性葡萄球菌(76例,占24.6%)和金黄色葡萄球菌(52例,占16.9%);革兰阴性(G-)菌居于次要地位,共检出96例次,占23.8%.感染G-菌患者脑脊液各指标整体水平较感染G+菌恶化,感染G-菌患者脑脊液蛋白含量〔mg/L:1795(1999)比1068(1251)〕、白细胞计数〔WBC(×106/L):1069.5(5295.8)比446.5(1689.3)〕和中性粒细胞比例〔N:0.877(0.218)比0.788 (0.416)〕均明显高于G+菌(均P<0.05),但葡萄糖水平明显低于感染G+菌〔mmol/L:1.7(2.5)比2.6(1.7),P<0.05〕;G-菌出现时间略晚于G+菌〔d:9.0(10.0)比8.0(7.0)〕,以不动杆菌和其他阴性菌明显,但整体差异无统计学意义.结论 G+菌为神经外科颅内感染患者的主要致病菌,且有出现时间早于G-菌培养分离时间的趋势;G+和G-菌感染患者脑脊液中生化指标蛋白和葡萄糖含量及常规检查指标WBC、N比较差异有统计学意义,提示其具有潜在的鉴别两类细菌的价值.
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