摘要
目的探讨开颅手术患者术后颅内感染病原学特点及危险因素。方法选取医院2010年5月-2017年5月行开颅手术患者479例。回顾性分析患者的临床资料,行腰椎穿刺术采集脑脊液进行病原菌鉴定及分析发生感染危险因素。结果 479例行开颅手术患者术后颅内感染59例,感染率为12.32%;共分离培养病原菌70株,其中革兰阴性菌45株占64.29%,革兰阳性菌23株占32.86%,真菌2株占2.86%;鲍氏不动杆菌对阿米卡星和氨曲南耐药率较高,分别为95.65%和86.96%;铜绿假单胞菌对头孢他啶和阿米卡星耐药率较高,分别为90.91%和72.73%;金黄色葡萄球菌对青霉素和红霉素耐药率较高,分别为100.00%和83.33%;凝固酶阴性葡萄球菌对青霉素、红霉素和左氧氟沙星耐药率较高,分别为100.00%、85.71%和85.71%;手术时间、存在脑脊液漏、预防性应用抗菌药物、放置引流管为术后颅内感染的独立危险因素(P<0.05)。结论术后颅内感染病原菌以革兰阴性菌为主,应根据病原菌特点和耐药性分析合理应用抗菌药物,根据独立危险因素采用相应对策,降低术后颅内感染发生率。
OBJECTIVE To investigate the pathogenic characteristics and risk factors of intracranial infection after craniotomy.METHODS A total of 479 patients undergoing craniotomy from May 2010 to May 2017 were selected.The clinical data of the patients were retrospectively analyzed.Lumbar puncture was performed to collect cerebrospinal fluid for pathogenic bacteria identification,and risk factors of infections were analyzed.RESULTSIn 479 cases of craniotomy,59 cases were intracranial infections,and the infection rate was 12.32%.Totally 70 strains of pathogens were isolated and cultured,among which 45 strains were gram-negative bacteria,accounting for 64.28%,23 strains were gram-positive bacteria,accounting for 32.86%,and 2 strains were fungi,accounting for 2.86%.Acinetobacter baumannii had high resistant rates to amikacin and aztreonam,which were 95.65% and 86.96% respectively,and the resistant rates of Pseudomonas aeruginosa to ceftazidime and amikacin were 90.91% and 72.73%,respectively.Staphylococcus aureus had high resistant rates to penicillin and erythromycin,which were respectively 100% and 83.33%,and coagulase-negative Staphylococcus had high resistant rates to penicillin,erythromycin and levofloxacin,which were 100%,85.71% and 85.71%,respectively.Univariate and multivariate analysis showed that operation time,cerebrospinal fluid leakage,antibiotic prophylaxis and drainage tube were independent risk factors of postoperative intracranial infections（P〈0.05）.CONCLUSION The pathogens of intracranial infections after operation are mainly gram-negative bacteria,antimicrobial drugs should be rationally applied according to the characteristics of pathogens and drug resistance.According to independent risk factors,the corresponding countermeasures are adopted to reduce the incidence of postoperative intracranial infection.
作者
邱政
郑绍俭
张晓东
陈晟
熊建平
QIU Zheng ZHENG Shao-jian ZHANG Xiao-dong CHEN Sheng XIONG Jian-ping(The Second Affiliated Hospital of Zhejiang University Jiande branch, Jiande, Zhejiang 311600, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第20期4693-4696,共4页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生一般研究计划基金资助项目(2015KYA106)
关键词
开颅手术
术后颅内感染
病原菌
危险因素
Craniotomy
Postoperative intracranial infection
Pathogenic bacteria
Risk factors
