神经外科患者术后颅脑感染的病原学特点及高危因素分析

发布时间：2018-06-03 08:43

本文选题：神经外科 + 术后颅脑感染　；参考：《中国病原生物学杂志》2017年06期

【摘要】：目的分析神经外科患者术后颅脑感染的病原学特点,并对病原菌的临床耐药情况及感染相关因素进行分析,为神经外科患者术后颅脑感染的防控提供科学指导。方法收集神经外科术后颅脑感染患者临床资料,从送检脑脊液标本中分离病原菌,采用全自动微生物鉴定仪进行菌株鉴定,采用K-B法分析病原菌的耐药性。结果 266例神经外科患者中,术后颅内感染80例,感染率30.08%。从80例感染患者脑脊液标本中共分离84株病原菌,其中革兰阳性菌53株,革兰阴性菌29株,真菌2株。革兰阳性菌中,凝固酶阴性葡萄球菌27株,金黄色葡萄球菌12株,粪肠球菌12株,其他4株;革兰阴性菌中,鲍曼不动杆菌16株,肺炎克雷伯菌6株,大肠埃希菌3株,铜绿假单胞菌2株,其他2株。凝固酶阴性葡萄球菌和金黄色葡萄球菌对环丙沙星、头孢他啶、头孢曲松、氯霉素和万古霉素的耐药率分别为33.33%、44.44%、40.74%、55.56%、0和33.33%、66.67%、58.33%、66.67%、0;粪肠球菌对环丙沙星、头孢他啶、头孢曲松、氯霉素、莫西沙星、加替沙星的耐药率分别为30.00%、50.00%、40.00%、60.00%、10.00%和10.00%。鲍曼不动杆菌和肺炎克雷伯菌对环丙沙星、头孢他啶、美罗培南、头孢曲松、氯霉素的耐药率分别为37.50%、50.00%、18.75%、43.75%、50.00%和33.33%、50.00%、0、50.00%、33.33%。年龄60岁患者颅脑感染率为17.80%,≥60岁者为39.86%;有脑室外引流者感染率为47.78%,无脑室外引流者为21.20%;有脑脊液外漏者感染率为45.63%,无脑脊液外漏者为20.25%;术前使用抗生素者感染率为53.27%,术前未使用抗生素者为14.47%;感染率差异均有统计学意义(χ2=15.2040,20.2696,19.3411,45.7982,P均0.05)。结论在神经外科患者术后颅脑感染的病原学特点分析中,病原菌类型以革兰阳性菌居多,其中又以凝固酶阴性葡萄球菌分离率最高,临床应高度重视此类病原菌的传播扩散。鉴于临床分离株的耐药程度,临床应合理选用抗菌药物,高效防治神经外科患者术后颅脑感染发生。神经外科患者年龄、脑室外引流、脑脊液外漏以及术前使用抗生素情况是发生颅脑感染的相关因素,临床应给予这些因素重视,并且对病原菌耐药性分析对治疗患者意义重大。
[Abstract]:Objective to analyze the etiology of postoperative craniocerebral infection in Department of Neurosurgery, and to analyze the clinical resistance and related factors of pathogenic bacteria, and to provide scientific guidance for the prevention and control of craniocerebral infection after operation in Department of neurosurgery. Methods the clinical data of the patients with craniocerebral infection after the operation were collected and the samples were separated from the specimens of the cerebrospinal fluid. The pathogenic bacteria were identified by the automatic microbial identification instrument and the K-B method was used to analyze the drug resistance of the pathogenic bacteria. Results in 266 Department of neurosurgery patients, 80 cases were infected with intracranial infection, and the infection rate of 30.08%. was isolated from 80 cases of the cerebrospinal fluid samples from the infected patients. Among them, 53 strains of Gram-positive bacteria, 29 Gram-negative bacteria and 2 fungi. Among Gram-positive bacteria, 27 strains of coagulase negative staphylococcus, 12 strains of Staphylococcus aureus, 12 strains of Enterococcus faecalis, 4 other strains, 16 strains of Acinetobacter Bauman, 6 Klebsiella pneumoniae, 3 Escherichia coli, 2 Pseudomonas aeruginosa, 2 strains, coagulase negative Staphylococcus and Staphylococcus aureus to ciprofloxacin, the head of ciprofloxacin, and the head of ciprofloxacin. The resistance rates of sporotazidime, ceftriaxone, chloramphenicol, and vancomycin were 33.33%, 44.44%, 40.74%, 55.56%, 0 and 33.33%, 66.67%, 58.33%, 66.67%, 0; the resistance rates of Enterococcus faecalis to ciprofloxacin, ceftazidime, ceftriaxone, chloramphenicol, moxifloxacin, and gatifloxacin were respectively 30%, 50%, 40%, 60%, and 10.00%. Bauman. The resistance rates of bacteria and Klebsiella pneumoniae to ciprofloxacin, ceftazidime, meropenem, ceftriaxone, chloramphenicol were 37.50%, 50%, 18.75%, 43.75%, 50% and 33.33%, 50%, 0,50.00%, and 60 years old were 17.80%, and 60 years old were 39.86%, and the infection rate of external ventricular drainage was 47.78% and no external ventricular drainage. The infection rate was 21.20%, the infection rate of the cerebrospinal fluid leakage was 45.63%, the non cerebrospinal fluid leakage was 20.25%, the infection rate was 53.27% before operation and 14.47% before the operation, and the difference of infection rate was statistically significant (x 2=15.2040,20.2696,19.3411,45.7982, P 0.05). In the analysis of the original characteristics, the types of pathogenic bacteria are mostly Gram-positive bacteria, and the isolation rate of coagulase negative staphylococcus is the highest, and the spread of this pathogen should be paid great attention to. In view of the degree of drug resistance of the clinical isolates, the antibiotics should be rationally selected in clinical, and the head infection of the patients in the Department of neurosurgery is highly effective. Surgical patients' age, external ventricular drainage, cerebrospinal fluid leakage, and preoperative use of antibiotics are related factors for the occurrence of craniocerebral infection. These factors should be paid attention to, and the analysis of drug resistance to pathogenic bacteria is of great significance for the treatment of patients.
【作者单位】：三峡大学第三临床医学院葛洲坝集团中心医院;
【分类号】：R651

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