Intracranial Acinetobacter baumannii infection is a rare clinical disease with a gradual increase in incidence and extremely high mortality. With the continuous enhancement of bacterial resistance, more and more intracranial infections of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii have appeared in the clinic, and its treatment has become a major challenge and problem faced by neurosurgeons. The treatment difficulties include the selection, usage and dosage of antimicrobial agents, as well as whether cerebrospinal fluid drainage is needed. A standardized treatment plan is still needed. In this paper, combining domestic and foreign literature, the treatment of intracranial infection of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii will be reviewed in order to provide a reference for clinical treatment.
目的 总结近十年来颅脑手术后颅内感染的发病率、病死率及病原菌谱，为制订预防颅内感染措施提供依据。 方法 检索中国学术期刊网全文数据库（CNKI）、万方数据库、重庆维普中文科技期刊全文数据库，并辅以文献追溯、手工检索等方法收集2001年－2012年国内正式刊物上公开发表的有关颅脑手术后颅内感染的中文文献。并对颅脑手术后颅内感染的流行病学调查资料进行Meta分析。 结果 共有27篇论文进入Meta分析，其中，25篇论文用于颅脑手术后颅内感染发病率的统计。共调查40 343例，发生颅内感染1 712例，感染率为4.24%。6篇论文提供了开颅术后颅内感染死亡的数据，在268例颅内感染患者中死亡39例，病死率为14.55%。15篇论文统计显示，颅内感染细菌培养阳性率为54.48%；15篇论文给出细菌培养结果，其中金黄色葡萄球菌占23.16%，表皮葡萄球菌占17.85%，铜绿假单胞菌占8.85%，大肠埃希菌占8.70%。 结论 国内颅脑手术后颅内感染以G+球菌为主，病原菌分布相对集中，临床上应予以重视。
ObjectiveTo establish a method that can eliminate the pollution of endogenous nucleic acid in the real-time quantitative polymerase chain reaction (PCR) reaction system, which can be used to reduce or eliminate the false positive rate of real-time PCR assay in detection of postoperative intracranial bacteria infection.MethodsAt first, eliminated the pollution of endogenous nucleic acid in the real-time PCR reaction system. Then, with mixed bacteria DNA as a template, multiple PCR was used to specifically identify the gram-negative bacteria. Meanwhile, evaluated the text line and sensitivity of the multiple PCR after eliminating pollution in detecting the DNA of the mixed bacteria.ResultsThe method established could quickly eliminate the pollution of endogenous nucleic acid in the real-time PCR reaction system, and it didn’t affect the Taq enzyme activity and the amplification efficiency in PCR system, with the minimum detection limit of 102 CFU/mL (Staphylococcus aureus and Pseudomonas aeruginosa), which was the same to the culture method. The enzyme cutting method had no significant effect on the activity and amplification efficiency of the enzyme in PCR system, It had no effect on PCR reaction system and primer specificity (Ct=32, ΔRn=200). However, the filtration method significantly reduced the PCR amplification efficiency (Ct=32, ΔRn=150).ConclusionsThis method can easily and rapidly eliminate the pollution of endogenous nucleic acid in the real-time PCR reaction system, and greatly reduce the false positive of PCR detection. It is able to timely and accurately diagnose the intracranial bacteria infection, which is significant for clinical testing.
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 外引流组经持续腰池置管脑脊液外引流治疗后，颅内感染临床症状明显缓解，脑脊液有核细胞数和脑脊液微量蛋白含量显著降低、脑脊液葡萄糖和氯化物浓度升高（Plt;0.05）。治疗10 d后，外引流组体温、脑脊液有核细胞数、脑脊液微量蛋白含量、脑脊液葡萄糖和氯化物浓度的改善程度明显优于抗生素组（Plt;0.05）。 结论 持续腰池置管脑脊液外引流治疗颅内感染具有安全性高、操作简便、观察颅内感染情况方便的优点，可作为颅内感染可靠治疗手段。【Abstract】 Objective To observe the efficacy of continuous lumbar drainage of cerebrospinal fluid via a lumbar catheter in treating intracranial infection. Methods From September 2008 to November 2009, 20 patients with intracranial infection after head trauma were enrolled in this study. Ten of them, classified as the external drainage group, sustained continuous external lumbar drainage of cerebrospinal fluid. The cerebrospinal fluid was obtained regularly for routine and biochemical examination. The other 10 patients were categorized as the antibiotics group. They only accepted intravenous antibiotic therapy. Results For the patients in the external drainage goup, after continuous external lumbar drainage of cerebrospinal fluid, their clinical symptoms of intracranial infection were significantly alleviated and the number of nucleated cells and protein content in the cerebrospinal fluid decreased significantly, while the glucose and chloride concentrations increased significantly (Plt;0.05). After 10 days of treatment, the patients in the external drainage group were superior to those in the antibiotics group in improvement of the body temperature, the number of nucleated cells and protein content, glucose and chloride concentrations in the cerebrospinal fluid (Plt;0.05). Conclusion Continuous lumbar drainage of cerebrospinal fluid is simple and safe. It provides an easy way of monitoring the intracranial infection and can be a reliable treatment.