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目的观察与分析开颅患者术后颅内感染鲍氏不动杆菌(ABA)的耐药性及临床治疗方法,为合理制定治疗方案提供参考依据。方法选取2012年1月-2014年12月术后颅内ABA感染患者50例,给予美罗培南静脉滴注联合鞘内注射及腰大池穿刺置管持续引流治疗,对患者脑脊液标本中培养分离出的ABA耐药性、治疗前后脑脊液中的白细胞计数、蛋白质、葡萄糖水平及临床疗效进行观察和比较。结果术后颅内感染患者脑脊液中检出50株ABA,其对头孢噻吩、头孢西丁、头孢呋辛的耐药率均较高,分别为100.0%、98.0%和96.0%,而对美罗培南、亚胺培南、头孢吡肟的耐药率较低,分别为54.0%、56.0%和60.0%;颅内ABA感染患者的脑脊液中白细胞计数、蛋白质较治疗前显著下降,葡萄糖水平较治疗前显著上升(P<0.05),临床治疗有效率为94.0%。结论开颅患者术后颅内感染ABA的耐药性较高,应用美罗培南静脉滴注联合鞘内注射及腰大池穿刺置管持续引流治疗具有较好的临床疗效。
Objective To observe and analyze the drug resistance and clinical treatment of intracranial infection of Acinetobacter baumannii (ABA) after craniotomy in craniotomy patients, so as to provide a reference for the rational formulation of treatment plans. Methods Fifty patients with intracranial ABA infection from January 2012 to December 2014 were selected. Meropenem intravenous drip combined with intrathecal injection and continuous drainage of lumbar cistern catheterization were performed. ABA resistance, white blood cell counts in cerebrospinal fluid before and after treatment, protein, glucose levels and clinical efficacy were observed and compared. Results Fifty strains of ABA were detected in cerebrospinal fluid of patients with intracranial infection after surgery. The rates of resistance to cefalotin, cefoxitin and cefuroxime were all 100.0%, 98.0% and 96.0% , Imipenem and cefepime were 54.0%, 56.0% and 60.0%, respectively; the cerebrospinal fluid CSF of patients with intracerebral ABA infection significantly decreased the white blood cell count and protein, and the glucose level was significantly lower than that before treatment (P <0.05), and the effective rate of clinical treatment was 94.0%. Conclusion The intracranial infection of ABA in patients after craniotomy is more resistant. The application of Meropenem intravenous drip combined with intrathecal injection and continuous drainage of lumbar cistern catheterization has good clinical efficacy.