住院患者感染病原菌分布特点及耐药性变迁的研究

目的研究医院住院患者感染病原菌的分布特点及其耐药性的变迁,指导临床合理使用抗菌药物。方法采用回顾性调查方法,对本医院2011年度临床分离的病原菌分布特点及其耐药性进行了调查与分析。结果2011年度该医院临床标本共分离出病原菌1 010株,其中革兰阴性菌占72.2%,革兰阳性菌占27.8%。肠杆菌科和铜绿假单胞菌对亚胺培南较敏感,鲍曼不动杆菌中多重耐药株占36.6%。耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和耐万古霉素肠球菌属(VRE)检出率分别为42.0%、56.9%和50.0%。大肠埃希菌和克雷伯菌中产超广谱β-内酰胺酶(ESBLs)菌株分别占革兰阴性菌的53.2%和31.2%。结论医院临床病原菌分布广泛,耐药性趋势变化日趋严重,革兰阴性菌中ESBLs菌株和革兰阳性菌中MRSA菌株都不断增加。     

老年患者下呼吸道感染病原分析及耐药性监测

目的 了解近年来老年患者下呼吸道感染病原菌耐药特点,为临床合理使用抗生素提供科学依据.方法 采用纸片扩散法对本院3年内自老年患者痰培养标本中分离的病原菌进行体外药敏试验,分析常见病原菌的耐药状况.结果 分离出临床菌株1161株,分别为革兰阴性菌966株(83.2%),革兰阳性菌129株(11.1%),真菌66例(5.7%).革兰阴性菌中主要病原菌依次为铜绿假单胞菌(27%)、鲍曼不动杆菌(20.7%)、肺炎克雷伯菌(10.2%)、大肠埃希菌(5.5%).革兰阳性菌中耐甲氧西林金黄色葡萄球菌(MRSA)占葡萄球菌属的84.3%,甲氧西林敏感金黄色葡萄球菌(MSSA)占15.7%.头孢哌酮/舒巴坦对铜绿假单胞菌、不动杆菌和肠杆菌科细菌抗菌活性均较高.亚胺培南和美罗培南对不动杆菌的耐药率超过60%.结论 老年患者下呼吸道感染以革兰阴性菌为主,细菌耐药现象严重,应根据药敏试验结果合理选择抗菌药物.     

血培养病原菌的分布及耐药性分析

目的:了解本院血培养病原菌的分布及常见致病菌的耐药特点,为临床用药提供依据。方法:采用Bact/Alert120进行自动血培养,并以Vitek-32微生物分析系统进行细菌鉴定及药敏分析。结果:10 291份临床标本中分离出病原菌651株。其中,革兰阳性菌323株(49.62%),革兰阴性菌265株(40.71%),真菌63株(9.68%)。在革兰阳性球菌中最常见的为血浆凝固酶阴性葡萄球菌,占革兰阳性菌63.78%,占总分离菌31.64%;其次为肠球菌,占革兰阳性菌16.10%,占总分离菌7.99%。革兰阴性菌中最常见的为大肠埃希菌,占18.13%,占革兰阴性菌的44.15%。葡萄球菌中耐甲氧西林凝固酶阴性葡萄球菌和耐甲氧西林金黄色葡萄球菌的分离率分别为83.98%和59.26%,未发现对万古霉素耐药菌株。屎肠球菌对青霉素及氨苄青霉素全部耐药,对庆大霉素的耐药率较高。革兰阴性菌中产超广谱β-内酰胺酶的大肠埃希菌和肺炎克雷伯菌检出率分别为56.78%和40.00%,对亚胺培南、头孢西丁耐药率较低;铜绿假单胞菌除对亚胺培南、头孢他啶、庆大霉素、奈替米星较为敏感外,对其他抗生素均有较高的耐药性。结论:血培养病原菌以条...     

477例中枢神经系统感染脑脊液培养阳性患者的临床特征及病原菌耐药性分析

目的 分析477例中枢神经系统感染脑脊液培养阳性患者的临床特征及耐药性,为临床合理用药提供依据。方法 收集2019年1月—2020年12月南京医科大学附属儿童医院儿童患者与南京医科大学附属脑科医院成人患者脑脊液标本数据,对分离的病原菌种类及耐药性进行回顾性分析。结果 从收集的4 149份脑脊液标本中,共分离病原菌477株,阳性率11.49%,神经外科送检阳性率(12.62%)最高;成人组患者脑脊液培养阳性检出率较高,儿童组患者检出阳性率较低;72.3%的患者有临床发热症状,90.5%的患者有基础疾病;药敏试验结果显示,耐甲氧西林凝固酶阴性葡萄球菌、耐甲氧西林金黄色葡萄球菌与对应的敏感菌相比耐药性较高;鲍曼不动杆菌对亚胺培南、美罗培南的耐药率分别为73.2%和70.7%,高于其他革兰阴性菌。结论 脑脊液培养及相关实验室指标对中枢神经系统感染诊断及治疗具有重要临床意义。     

黑龙江某院临床分离病原菌的分布及耐药性分析

目的回顾性分析黑龙江省某院2016年1月1日至2016年3月31日临床分离病原菌的分布和耐药特点,为临床抗菌药物的使用提供依据。方法采用HH.CP-01W二氧化碳培养箱及BACT/ALERT 3D全自动血培养仪进行标本培养,使用黑马DL-96鉴定系统进行菌株鉴定和药敏试验。结果送检的5 285份标本共分离病原菌825株,其中革兰阴性菌496株,占60.1%;革兰阳性菌268株,占32.4%;念珠菌61株,占7.4%。耐甲氧西林金黄色葡萄球菌(MRSA)占金黄色葡萄球菌56.9%,耐甲氧西林凝固酶阴性葡萄球菌(MRCON)占凝固酶阴性葡萄球菌56.0%,未检出对万古霉素和利奈唑胺耐药的阳性菌。结论严格执行标本的前处理过程有助于提高标本的阳性检出率,临床医师在经验用药的基础上应重视药敏监测结果,严格用药指征,从而做到合理应用抗菌药物。     

853份中段尿培养及耐药性分析

目的分析泌尿系统感染患者中段尿病原菌的分布及耐药情况,为临床合理应用抗菌药物提供依据。方法对该院2014年1~12月送检的853份中段尿标本进行培养,并对分离病原菌进行细菌鉴定和耐药性分析。结果共245份中段尿标本分离出病原菌,阳性率为28.7%;共检出病原菌菌株269株,以革兰阴性菌为主(60.2%),其次为革兰阳性菌(33.8%)、真菌(5.9%)。检出产超广谱β-内酰胺酶(ESBLs)大肠埃希菌48株,产ESBLs肺炎克雷伯菌3株;耐甲氧西林表皮葡萄球菌(MRSE)和耐甲氧西林金黄色葡萄球菌(MRSA)检出率分别为17.6%、35.8%;未检出耐万古霉素的葡萄球菌。结论临床医生要依据细菌药物敏感试验结果科学合理地选用抗菌药物,防止盲目经验用药,减少及控制ESBLs阳性菌株和其他耐药菌株的产生及传播。     

新生儿病房病原菌分布及耐药性分析

目的了解本院新生儿病房病原菌的分布及耐药性,为临床用药提供依据。方法回顾性调查分析2010年6月至2011年12月新生儿病房送检标本中分离的245株病原菌,用Vitek-2全自动微生物鉴定系统进行鉴定及药敏试验。结果 245株病原菌中,革兰阳性球菌84株(占34.3%),革兰阴性杆菌158株(占64.5%),以咽拭子检出率最高(40.0%)。主要病原菌为肺炎克雷伯菌、大肠埃希菌、表皮葡萄球菌、金黄色葡萄球菌。革兰阴性杆菌和葡萄球菌属对常用抗菌药物耐药严重,且呈多药耐药。革兰阴性杆菌产超广谱β-内酰胺酶(ESBLs)的检出率为70.9%;未检出耐甲氧西林金黄色葡萄球菌(MRSA),耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率为58.5%,无耐万古霉素葡萄球菌检出。结论新生儿病房病原菌以革兰阴性杆菌为主,对常用抗菌药物耐药严重,应动态监测病原菌流行株及其耐药情况,合理使用抗菌药物。     

苏州某中医院血流感染病原菌分布及耐药性分析

目的 分析血培养标本中病原菌分布及其耐药性,为临床感染控制提供依据。方法 回顾性分析2016-2020年该院血培养标本分离的病原菌及药敏情况。结果 送检5 540份血培养标本中共分离出462株病原菌,其中革兰阳性菌161株(34.8%),革兰阴性菌292株(63.2%),真菌9株(1.9%)。排名前5位的病原菌分别是大肠埃希菌35.7%(165/462)、凝固酶阴性葡萄球菌13.4%(62/462)、肺炎克雷伯菌12.1%(56/462)、金黄色葡萄球菌5.6%(26/462)、阴沟肠杆菌3.0%(14/462)。耐甲氧西林金黄色葡萄球菌占金黄色葡萄球菌的34.6%(9/26),耐甲氧西林凝固酶阴性葡萄球菌占凝固酶阴性葡萄球菌的74.2%(46/62)。葡萄球菌属对万古霉素、替考拉宁、奎奴普丁/达福普汀、替加环素、利奈唑胺均保持敏感,未检出耐药菌株。大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率分别为2.4%、8.9%。结论 血培养标本分离病原菌种类多样,以革兰阴性菌为主,临床应重视血培养标本的送检及其耐药监测,合理使用抗菌药物,早期控制血流感染,降低患者病死率。     

1684株血培养阳性病原菌分布及耐药性分析

目的了解该院临床送检血培养阳性标本的病原菌分布及耐药情况,为临床合理使用抗菌药物提供重要依据。方法采用全自动微生物分析仪进行细菌培养、鉴定和药敏分析,结果按美国临床和实验室标准化协会(CLSI)2014年版标准判读,采用Whonet 5.6软件进行数据分析。结果 46 564份临床送检血培养标本中检出阳性菌3 614株,去除非重复菌株,共1684株,其中革兰阳性870株,占51.6%,革兰阴性菌738株,占43.8%,真菌36株,占2.1%。药敏结果分析显示革兰阳性菌对青霉素耐药率均较高大于90%,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)的检出率分别42.6%和73.0%,未发现对万古霉素和利奈唑胺耐药的葡萄球菌属,发现少数对万古霉素和利奈唑胺耐药的屎肠球菌。革兰阴性菌中对氨苄西林耐药率最高(不低于64.3%),对亚胺培南和美罗培南耐药率最低,但铜绿假单胞菌对二者的耐药率较高,分别为41.5%和33.3%,鲍曼不动杆菌对亚胺培南耐药率为42.5%。结论凝固酶阴性葡萄球菌为该院血流感染的主要病原菌,并且耐药现象比较严重,临床医生应根据药敏结果合理选择抗菌药物。     

3 159份血液标本中病原菌的构成和耐药性分析

目的了解该院血液标本中检出病原菌的构成和耐药状况,以指导临床合理用药。方法该院2016年3 159份血液标本采用美国BD BACTEC9120全自动血液分析仪培养,血培养阳性标本采用法国梅里埃VITK2-compact全自动细菌鉴定和药敏系统进行鉴定和药敏实验,参照CLSI 2015年版判读结果,WHONET5.5软件进行数据分析。结果分离出病原菌216株,阳性率6.8%;其中革兰阴性菌104株,占48.1%;革兰阳性细菌92株,占42.6%;酵母样真菌20株,占9.3%。革兰阴性杆菌以大肠埃希菌和肺炎克雷伯菌为主,产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌检出率分别为40.3%和31.3%,未检出耐碳青霉烯类肠杆菌科细菌。革兰阳性菌以凝固酶阴性葡萄球菌(CNS)和金黄色色葡萄球菌为主,耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)和耐甲氧西林金黄色葡萄球菌(MRSA)的检出率分别为86.4%和10.0%,未见耐万古霉素和利耐唑胺葡萄球菌和肠球菌属细菌。结论该院血培养分离菌以革兰阴性杆菌为主,细菌耐药性仍是临床重要问题,应引起临床高度重视。     

脑脊液中肝素结合蛋白、总蛋白、降钙素原检测在鉴别细菌性与非细菌性颅内感染疾病中的临床应用

目的探讨脑脊液中肝素结合蛋白(HBP)、总蛋白、降钙素原(PCT)检测在鉴别细菌性与非细菌性颅内感染疾病中的临床应用价值。方法我院收治的颅内感染患者248例,分为细菌性颅内感染142例(细菌组)和非细菌性颅内感染106例(非细菌组),选取同期无颅内感染住院患者85例为对照组。比较三组血白细胞计数(WBC)、血清PCT以及脑脊液WBC、HBP、总蛋白、PCT水平。绘制ROC曲线计算灵敏度、特异度。结果细菌组血WBC、血清PCT及脑脊液WBC、HBP、总蛋白、PCT水平均高于非细菌组与对照组(P<0.05)。各指标鉴别细菌性与非细菌性颅内感染脑脊液HBP的截断值为21.30 ng/ml,灵敏度为75.35%,特异度为79.25%。脑脊液总蛋白的截断值为1054.50 mg/L,灵敏度为83.10%,特异度为70.75%。脑脊液PCT的截断值为0.16 ng/ml,灵敏度为88.03%,特异度为89.62%。结论脑脊液中HBP、总蛋白、PCT检测在鉴别细菌性与非细菌性颅内感染具有较高的价值,可与传统指标血WBC、脑脊液WBC以及血清PCT等联合应用,辅助临床诊断。     

内镜下脑脊液鼻漏修补术后颅内感染的影响因素

目的探究经鼻内镜下脑脊液鼻漏修补术后发生颅内感染的危险因素,以期能为后期治疗提供参考。方法选取2010年1月-2015年1月该院收治的80例经鼻内镜下脑脊液鼻漏修补术患者为研究对象,回顾性分析80例患者的临床资料,分析患者的年龄、性别、病因、漏口大小、漏口位置、既往有无颅内感染、预防性抗生素、术后应用抗菌药物7 d、手术次数、手术是否使用人工材料、修复材料的选择、脑脊液鼻漏修补失败与经鼻内镜下脑脊液鼻漏修补术后发生颅内感染的相关性。结果 80例患者中4例(5.00%)患者术后发生颅内感染,对4例患者进行脑脊液细菌培养,共分离出8株病原菌,包括3例革兰阴性菌和5株革兰阳性菌,革兰阳性菌主要为金黄色葡萄球菌,占40.00%。单因素分析结果显示,脑脊液鼻漏修补失败、手术操作不当、修复材料的选择、既往有颅内感染病史和漏口大小直径1 cm与经鼻内镜下脑脊液鼻漏修补术后发生颅内感染有一定的相关性(P0.05)。多因素Logistic分析结果显示,脑脊液鼻漏修补失败、手术操作不当、既往有颅内感染病史、修复材料的选择和漏口大小直径1 cm为经鼻内镜下脑脊液鼻漏修补术后发生颅内感染的独立危险因素(P0.05)。结论颅底漏口大小直径1 cm、有既往颅内感染史、脑脊液鼻漏修补失败和手术失败因素等多种因素均可能会增大经鼻内镜下脑脊液鼻漏修补术患者术后颅内感染的发生率。     

颅内动脉瘤介入治疗后早期持续腰大池引流对脑血管痉挛的影响

目的:探讨颅内动脉瘤破裂出血介入治疗后早期持续腰大池引流对脑血管痉挛(CVS)的影响.方法:对60例Hunt-Hess分级为Ⅲ级的颅内动脉瘤破裂出血患者行介入治疗,并将其随机分为观察组36例和对照组24例,观察组给予早期持续腰大池引流,对照组给予间断腰穿释放脑脊液,比较两组并发症发生情况及脑脊液红细胞和压力参数等相关指标.结果:观察组脑脊液中红细胞计数和脑脊液压力从术后第3天开始明显低于对照组(P＜0.05),观察组CVS发生率明显低于对照组(P＜0.05).结论:动脉瘤介入治疗术后早期持续腰大池引流可有效防治CVS,值得临床推广应用.     

Therapy of malignant intracranial hypertension by controlled lumbar cerebrospinal fluid drainage

OBJECTIVES: To evaluate the effect of controlled lumbar cerebrospinal fluid drainage in adult patients with refractory intracranial hypertension. DESIGN: Prospective, pre- vs. postintervention study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: Twenty-three patients with severe traumatic brain injury or delayed ischemia after subarachnoid hemorrhage with intracranial hypertension refractory to aggressive treatment, including repeated applications of tromethamine, hypertonic saline solution, barbiturate coma, and decompressive craniectomy. Patients were considered for controlled lumbar cerebrospinal fluid drainage if basal cisterns on computerized tomography scan were discernible. INTERVENTIONS: After institution of a lumbar drain, cerebrospinal fluid was gradually aspirated, and then, continuous cerebrospinal fluid drainage was maintained under control of intracranial pressure (ICP) and pupillary status. MEASUREMENTS AND MAIN RESULTS: ICP and cerebral perfusion pressure before and after initiation of lumbar cerebrospinal fluid drainage and related complications were documented. The neurologic outcome of the patients was assessed according to the Glasgow Outcome Scale 6 months after injury. As a result of lumbar cerebrospinal fluid drainage, all patients demonstrated an immediate and lasting decrease of ICP and a concomitant increase of cerebral perfusion pressure. Two patients temporarily showed a unilateral fixed and dilated pupil 6 and 8 hrs after onset of lumbar cerebrospinal fluid drainage, respectively. Ten patients showed a favorable outcome, four patients survived with a severe permanent neurologic deficit, one patient remained in a persistent vegetative state, and eight patients died. CONCLUSIONS: Controlled lumbar cerebrospinal fluid drainage significantly reduces refractory intracranial hypertension. The danger of transtentorial or tonsillar herniation is minimized by considering lumbar drainage in the presence of discernible basilar cisterns only.     

腰池置管脑脊液外引流治疗颅内感染临床分析

目的 观察持续腰池置管脑脊液外引流治疗颅内感染的疗效.方法 2008年9月-2009年11月,将20例颅脑外伤后颅内感染患者分为脑脊液外引流组和抗生素组各10例,外引流组进行持续腰池置管脑脊液外引流,定期取引流脑脊液进行常规和生化检查;抗生素组采用静脉抗生素治疗.对两组颅内感染情况进行对比分析.结果 外引流组经持续腰...     

Increases in spinal fluid osmolarity induced by mannitol

OBJECTIVE: Mannitol is widely used in hospitals worldwide to treat patients with high intracranial pressure and/or cerebral edema. One of the mechanisms by which mannitol is thought to affect intracranial pressure is by increasing the patient's serum osmolarity, but not the osmolarity in the brain or cerebrospinal fluid. In this way, mannitol is thought to increase the osmolarity gap between the brain and the blood, which in turn leads to removal of excess water from the brain. However, relatively little is known regarding long-term effects of mannitol on osmolarity of cerebrospinal fluid. We therefore sought to determine the effects of mannitol administration on the osmolarity of cerebrospinal fluid. DESIGN: Controlled trial. SETTING: University teaching hospital. PATIENTS: Patients with severe head injury and patients with subarachnoid bleeding who required insertion of an intracranial probe. MEASUREMENTS AND MAIN RESULTS: Serum and cerebrospinal fluid osmolarity were measured before and during mannitol administration in ten patients treated with mannitol for >or=72 hrs (group 1), ten patients treated for 24 to 48 hrs (group 2), and ten controls (group 3). Serum osmolarity increased quickly in all patients receiving mannitol (groups 1 and 2), whereas remaining constant in controls. Average cerebrospinal fluid osmolarity slowly increased in all patients receiving mannitol; cerebrospinal fluid osmolarity increased from (mean +/- sd) 291.5 +/- 4.0 to 315.5 +/- 4.5 mOsm/kg after 96 hrs in group 1 (p <.01), and from 288.9 +/- 3.5 to 296.9 +/- 6.2 mOsm/kg after 48 hrs in group 2 (p <.01). Cerebrospinal fluid osmolarity remained constant in controls (p <.01 for group 1 vs. group 3 and for group 2 vs. group 3, respectively). In group 1, the gap between serum and cerebrospinal fluid osmolarity initially increased (which was the desired effect), but later decreased first to baseline values and then to below-normal levels. CONCLUSIONS: Long-term administration of mannitol can induce significant increases in cerebrospinal fluid osmolarity in patients with subarachnoid hemorrhage or severe head injury. This may be an undesirable and potentially dangerous effect. Therefore, cerebrospinal fluid osmolarity should be measured regularly in all patients receiving mannitol for longer than 24 hrs. If cerebrospinal fluid osmolarity increases, discontinuation or tapering of mannitol therapy should be considered.     

持续腰大池引流在神经外科治疗中的应用

目的探讨持续腰大池引流在神经外科中应用的临床疗效。方法回顾性分析2004年7月至2009年10月经持续腰大池引流脑脊液治疗的110例神经外科患者的临床资料。在110例患者中,难治性脑脊液漏12例,颅内感染13例,蛛网膜下腔出血40例,脑室内出血45例。结果 12例脑脊液漏患者全部治愈,13例颅内感染患者治愈12例,40例蛛网膜下腔出血患者治愈38例,45例脑室内出血患者积血全部清除。引流期间无再出血、脑疝及继发颅内感染等并发症发生。结论持续腰大池引流脑脊液是治疗难治性脑脊液漏、颅内感染、蛛网膜下腔出血及脑室内出血的一种安全、有效的方法 。     

Serum procalcitonin in cerebral ventriculitis

OBJECTIVES: The objective of this study was to test the hypothesis that serum procalcitonin is increased in patients with bacterial cerebral ventricular infections after the insertion of temporary external ventricular drains. PATIENTS AND METHODS: This open, prospective study included patients requiring temporary external ventricular drains for various neurologic conditions such as intracerebral hemorrhage with ventricular hemorrhage or space-occupying lesions in the posterior fossa (cerebellar infarctions or hemorrhages). Patients experiencing primary central nervous system infection or sepsis were excluded. Procalcitonin, C-reactive protein, and white blood cell count were measured daily. Cerebrospinal fluid was investigated every other day, including cerebrospinal fluid cell count, lactate, glucose, and cerebrospinal fluid culture. Results were categorized according to presence of bacterial cerebrospinal fluid infection as determined by positive cerebrospinal fluid cultures. RESULTS: A total of 34 consecutive patients were included. Procalcitonin was significantly higher (4.7 vs. 0.2 ng/mL) in patients with proven bacterial ventriculitis. Cerebrospinal fluid cell count (456 vs. 478 cells/microL) could not distinguish bacterial infection from abacterial reactions, mainly because of blood contamination of the cerebrospinal fluid. CONCLUSION: Cerebrospinal fluid of patients treated with temporary external ventricular drains is frequently characterized by blood contamination because of the insertion procedure, the underlying neurologic disorder such as ventricular hemorrhage, or the presence of an abacterial chemical ventriculitis. Thus, diagnosis of a bacterial ventricular infection requiring immediate antibiotic therapy is less certain. Serum procalcitonin adds to the diagnostic precision in bacterial ventriculitis.     

Treatment of bacterial meningitis with ceftizoxime.

Ceftizoxime was evaluated in the treatment of 18 patients (6 adults and 12 children) with bacterial meningitis. In seven patients Haemophilus influenzae was the causative agent, in three Neisseria meningitidis, in five Streptococcus pneumoniae, and in one each alpha-streptococcus and Escherichia coli; one case was culture negative. Ceftizoxime was administered intravenously in doses of 200 mg/kg per day. Clinical response was appropriate in all patients with a mean time of defervescence of 3.7 days, and sterile cerebrospinal fluid was obtained from all patients at 24 to 36 h after initiation of therapy. The mean concentration of ceftizoxime in 46 cerebrospinal fluid samples obtained during therapy was 8.53 micrograms/ml (range, less than 0.5 to 29.0 micrograms/ml). Ceftizoxime concentrations in cerebrospinal fluid samples were ten- to several hundredfold the bactericidal concentrations of the pathogens isolated from the cerebrospinal fluid. Ceftizoxime penetrates the meninges well during acute infection and appears to be an excellent candidate antibiotic in the treatment of bacterial meningitis.     

Cerebrospinal fluid tumor necrosis factor-alpha, interleukin-1beta, interleukin-6, and interleukin-8 as diagnostic markers of cerebrospinal fluid infection in neurosurgical patients

OBJECTIVE: To evaluate whether cerebrospinal fluid concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6, or IL-8 may be used as diagnostic markers for the differential diagnosis of aseptic vs. bacterial meningitis and/or ventriculitis in neurosurgical patients. DESIGN: Prospective, observational study. SETTING: University teaching hospital. SUBJECTS: A total of 112 cerebrospinal fluid samples from 14 asymptomatic patients with normal cerebrospinal fluid after neurosurgery, 27 asymptomatic and 19 symptomatic patients with postneurosurgical aseptic meningitis, 32 patients with postneurosurgical cerebrospinal fluid infection, and 20 with severe subarachnoid and/or cerebral hemorrhage. MEASUREMENTS AND MAIN RESULTS: Specific ELISA kits were used to analyze TNF-alpha, IL-1beta, IL-6, and IL-8 concentrations on cerebrospinal fluid samples. Elevations in cerebrospinal fluid concentrations of TNF-alpha, IL-1beta, IL-6, and IL-8 were induced by different diseases or neurosurgical procedures, but cerebrospinal fluid bacterial infection induced the highest concentrations. To discriminate between aseptic cerebrospinal fluid pleocytosis and cerebrospinal fluid infection with a specificity of 95%, cerebrospinal fluid leukocyte count >1700/mL, TNF-alpha >150 pg/mL, and IL-1beta >90 pg/mL showed sensitivities of 51%, 74%, and 90%, respectively. Sufficiently sensitive and specific cutoff points could not be found for cerebrospinal fluid IL-6 or IL-8. CONCLUSION: Cerebrospinal fluid IL-1beta appears to be the best biochemical marker of cerebrospinal fluid infection in neurosurgical patients.