神经外科术后颅内感染患者的抗生素使用

摘要

Objective To understand the situation of antibiotics use and intracranial infections in postoperative patients in neurosurgical department. Methods The data of the time of intracranial infection, bacteria detected in cerebrospinal fluid( CSF) culture and the use of the antibiotics were collected in patients who underwent neurosurgery from January 2009 to June 2011. Results Among 21 067 cases, positive results of CSF culture accounted for 1. 2% (253 cases). The mean time from operation to intracranial infection occurrence was 7. 2 days, the time to obtain culture result was 10.2 days. The most frequently isolated bacterium was coagulase negative staphylococcus(28. 85% ) , followed by Staphylococcus aureus( 14.62% ) . Antibiotics were empirically used in all CSF positive patients. Antibiotics were sensitive in 33.4% of empiric use cases and 82.9% of the cases in whom antibiotics were used against specific targets were sensitive. Conclusion The positive rate of CSF culture was low. The coagulase negative staphylococci and Staphylococcus aureus play important role in intracranial infection. Though antibiotics are used often, adequate use should be emphasized.%目的 了解神经外科术后患者颅内感染情况及抗生素的使用.方法 回顾分析2009年1月至2011年6月,首都医科大学附属北京天坛医院神经外科开颅术后脑脊液培养阳性患者的感染时间、致病菌分布及抗生素应用等情况.结果 2009年1月至2011年6月共行神经外科开颅手术21 067例,脑脊液培养阳性者253例,占1.20％,患者术后平均感染发生时间为7.2d,术后病原学回报时间平均10.2 d.病原学培养结果中凝固酶阴性葡萄球菌所占比例最高,为28.85％,金黄色葡萄球菌为14.62％.所有脑脊液培养阳性患者均经验性使用抗生素治疗,在经验性治疗中,有33.4％的抗生素对致病菌敏感,目标性用药中82.9％为真正的抗生素敏感.结论 目前脑脊液细菌学培养阳性率较低；其中凝固酶阴性葡萄球菌和金黄色葡萄球菌是患者神经外科术后颅内感染的主要致病菌；经验性抗生素治疗的准确性有待提高.