鞘内注射替加环素治愈颅内感染鲍曼不动杆菌一例并文献回顾

Intrathecal Injection of Tigecycline in the Treatment of MDR-Ab Infection: A Case Report and Literature Review

摘要: 目的：观察颅脑术后产生多重耐药鲍曼不动杆菌(MDR-Ab)颅内感染的原因及鞘内注射替加环素治疗方案疗效。方法：分析青岛大学附属医院神经外科收治的1例脑内血肿清除术加去骨瓣减压术后出现脑脊液漏引起MDR-Ab颅内感染患者的临床资料；结合文献复习，分析颅内感染原因及MDR-Ab颅内感染的治疗方案。结果：本例患者住院过程中，因基础糖尿病导致伤口长期不愈合进一步引发脑脊液漏，后采用脑脊液培养及降钙素原检测脑脊液辅助诊断为颅内感染；先后使用抗生素为头孢曲松、邦达、美罗培南、替加环素 + 舒普深静脉注射，联合腰大池置管引流 + 替加环素鞘内注射，后清创缝合，治疗3周后患者颅内感染好转，脑脊液连续细菌培养阴性，患者临床症状明显好转。结论：对于脑脊液漏引起的MDR-Ab颅内感染，替加环素 + 舒普深静脉用药联合腰大池引流 + 替加环素鞘内注射有较好的治疗效果。

Abstract: Objective: To observe the causes of intracranial infection caused by multidrug-resistant Acineto-bacter baumannii (MDR-Ab) after craniocerebral surgery and the efficacy of intrathecal injection of tigecycline. Methods: The clinical data of a patient with MDR-Ab intracranial infection caused by cerebrospinal fluid leakage after decompressive craniectomy for intracerebral hematoma were an-alyzed. Combined with literature review, the etiology and treatment of intracranial infection of MDR-Ab were analyzed. Results: The patient was diagnosed as intracranial infection by cerebrospi-nal fluid assay, culture, and procalcitonin detection. The antibiotics were ceftriaxone, Bandar, meropenem, tigecycline and sulbactam, combined with lumbar cistern drainage, intrathecal injec-tion of tigecycline, debridement and suture. After 3 weeks of treatment, the patient’s intracranial infection improved, and the continuous bacterial culture of cerebrospinal fluid was negative. The clinical sign and symptom of the patients was significantly improved. Conclusion: For intracranial infection of MDR-Ab caused by cerebrospinal fluid leakage, the combination of tigecycline and sulperazon, lumbar drainage and intrathecal injection of tigecycline has a good therapeutic effect.