颅底肿瘤患者鼻内镜颅底手术术后颅内感染的病原菌分布与相关因素分析

发布时间：2018-05-15 19:18

本文选题：颅底肿瘤 + 鼻内镜颅底手术　；参考：《中华医院感染学杂志》2017年23期

【摘要】：目的探讨颅底肿瘤患者鼻内镜颅底手术术后颅内感染的病原菌分布与危险因素。方法选择2012年1月-2017年1月期间医院收治的行鼻内镜颅内手术的颅底肿瘤患者943例;对发生术后颅内感染的发生率及危险因素进行观察分析;对发生术后颅内感染患者脑脊液中的病原菌分布及耐药性进行比较分析。结果 943例患者中发生术后颅内感染的患者47例,感染率4.98%;47例感染患者分离培养病原菌69株,其中革兰阳性菌41株占59.42%,革兰阴性菌28株占40.58%;金黄色葡萄球菌对青霉素G、红霉素、利福平耐药率较高,凝固酶阴性葡萄球菌对红霉素和青霉素G耐药率较高;鲍氏不动杆菌对亚胺培南、头孢他啶耐药率较高,铜绿假单胞菌对阿米卡星和美罗培南耐药率较高;多因素Logistic回归分析结果显示:颅底重建、脑脊液鼻漏、颅底手术史、术前应用抗菌药物为术后颅内感染独立危险因素(P0.05)。结论颅底肿瘤患者鼻内镜颅底手术术后颅内感染以革兰阳性菌为主,术后颅内感染相关因素较多。应按照病原学类型采取针对性预防感染措施,且有效监测存在的感染因素,降低感染率。
[Abstract]:Objective to investigate the pathogenic bacteria distribution and risk factors of intracranial infection in patients with skull base tumor after endoscopic skull base surgery. Methods from January 2012 to January 2017, 943 patients with skull base tumor underwent endoscopic intracranial surgery were selected, and the incidence and risk factors of intracranial infection after operation were observed and analyzed. The distribution and drug resistance of pathogenic bacteria in cerebrospinal fluid (CSF) of patients with postoperative intracranial infection were compared and analyzed. Results among the 943 patients, 47 cases had postoperative intracranial infection, and the infection rate was 4.98%. 69 strains of pathogenic bacteria were isolated and cultured in 47 cases. Among them, 41 strains of Gram-positive bacteria accounted for 59.42 strains, 28 strains of Gram-negative bacteria accounted for 40.58 strains, Staphylococcus aureus for penicillin G, erythromycin, and Staphylococcus aureus for penicillin G and erythromycin. Rifampicin resistance rate was higher, coagulase-negative staphylococcus resistance rate to erythromycin and penicillin G was higher, Acinetobacter baumannii resistance rate to imipenem and ceftazidime was higher, and Pseudomonas aeruginosa resistance rate to amikacin and meropenem was higher. Multivariate Logistic regression analysis showed that: skull base reconstruction, cerebrospinal fluid rhinorrhea, history of skull base surgery, preoperative use of antibiotics as an independent risk factor for postoperative intracranial infection (P 0.05). Conclusion Gram-positive bacteria are the main cause of intracranial infection in patients with skull base tumor after endoscopic skull base surgery, and there are many factors related to intracranial infection after operation. Measures should be taken to prevent infection according to the type of etiology, and the infection factors should be monitored effectively to reduce the infection rate.
【作者单位】：浙江省肿瘤医院中药房;赣州市中医医院神经内科;浙江省肿瘤医院头颈放疗科;
【基金】：浙江省医药卫生基金资助项目(2015KYB369)
【分类号】：R739.41

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