2008—2017年脑脊液病原菌分布和药物敏感性分析

目的：统计分析2008—2017年南京医科大学第一附属医院临床送检脑脊液培养标本中主要病原菌分布及药物敏感性情况。方法：细菌鉴定、药物敏感试验和真菌鉴定采用 VITEK?2 Compact 全自动微生物鉴定及药敏系统，链球菌药敏为纸片扩散法（K?B 法），真菌药敏试验采用 ATB FUNGUS 3 方法，WHONET 5.6 软件进行统计分析。结果：2008—2017年南京医科大学第一附属医院脑脊液标本培养阳性率为6.0%，前5位的病原菌分别是鲍曼不动杆菌（35.8%），凝固酶阴性葡萄球菌（11.3%），肺炎克雷伯菌（9.3%），铜绿假单胞菌（5.8%），大肠埃希菌（5.1%）和新型隐球菌（5.1%）。鲍曼不动杆菌对常见抗菌药物敏感性均较低，肠杆菌科细菌对碳青霉烯类抗菌药物最敏感（>55.0%），铜绿假单胞菌对除氨曲南之外的抗菌药物均有较好的敏感性（>46.7%），革兰阳性球菌对万古霉素、利奈唑胺、替考拉宁敏感性较好，新型隐球菌对常见抗真菌药物均有较好的敏感性（>90.0%）。结论：2008—2017年脑脊液标本中，革兰阴性杆菌在中枢神经系统感染中占重要地位，应重点防范多重耐药菌的感染，尤其是鲍曼不动杆菌。统计并分析脑脊液常见病原菌和药物敏感性可为本地区临床医生合理用药提供理论依据。

Analysis the Distribution and Antibiotic Resistance of Bacterial Pathogens Isolated in Cerebrospinal Fluid during 2008 -2017

Objective To analysis the distribution and antibiotic resistance of bacterial pathogens isolated during the period from 2008 to 2017 in cerebrospinal fluid of The First Affiliated Hospital of Nanjing Medical University Methods Vitek2-Compact system was used for bacterial identification, drug sensitivity and fungal identification testing, KB was used for Streptococcus susceptibility testing, ATB FUNGUS 3 methods was used for fungi susceptibility testing, and then we use WHONET5.6 software for statistical analysis. Results cerebrospinal fluid culture positive rate was 6.0% during the period from 2008-2017 of The First Affiliated Hospital of Nanjing Medical University, the top five separated pathogenic bacterias were Acinetobacter baumannii(35.8%), Coagulase negative staphylococcus (11.3%), K. pneumoniae (9.3%), Pseudomonas aeruginos(5.8%), E.coli(5.1%), Cryptococcus neoformans(5.1%) respectively. The sensitivity rate of Acinetobacter baumannii to all kinds of antibiotics were not active. Carbapenems dugs(55.0%) were the most active aganist enterobacteriaceae. All kinds of antibiotics were more active against Pseudomonas aeruginosa other than aztreonam(>46.7%). Vancomycin, rizolazone and teicoplanin were the most active antibiotics against Gram positive coccus. Cryptococcus neoformans was active to all kinds of antifungal drugs(>90.0%). Conclusion the central nervous system infection is caused mainly by gram-negetive bacteria from 2008 to 2017 in cerebrospinal fluid. More attention should be paid to multiple drug resistant strains, expecially Acinetobacter baumannii. Statistical Analysis the distribution and antibiotic resistance of bacterial pathogens in cerebrospinal fluid could provide the theoretical basis for doctors to correct uses of antibiotics .