重症监护病房开颅术后患者颅内感染的调查

发布时间：2018-11-18 07:03

【摘要】：目的调查重症监护病房开颅术后患者颅内感染的病原菌分布及耐药性,并分析感染的相关因素,为临床治疗提供参考依据。方法选取2014年1月-2016年6月于医院收治的重症监护病房行开颅手术患者160例,通过对其临床资料进行回顾性分析,调查其感染率、病原菌分布情况及耐药性,并采用多因素Logistic回归分析对患者感染危险因素进行分析。结果 160例重症监护病房开颅手术患者,其中12例发生术后颅内感染,感染率为7.5%,12例感染病例共分离出病原菌22株,其中最多的为革兰阴性菌,占72.7%,其次为革兰阳性菌,占27.3%;鲍氏不动杆菌耐药率在50%以上的药物有头孢噻肟、氨苄西林、氨曲南及左氧氟沙星;肺炎克雷伯菌耐药率在50%以上的药物有环丙沙星、亚胺培南、阿米卡星及妥布霉素;金黄色葡萄球菌耐药率在50%以上的药物有亚胺培南、红霉素及左氧氟沙星;经多因素Logistic回归分析结果显示,影响开颅术后颅内感染的相关因素包括糖尿病史、手术时间延长、放置引流管、发生脑脊液漏及白蛋白水平低(P0.05)。结论重症监护病房开颅术后患者发生颅内感染的概率较高,影响开颅术后发生颅内感染的因素包括糖尿病史、手术时间延长、放置引流管、发生脑脊液漏及白蛋白水平低等,因此临床上应针对上述各种影响因素采取相关措施进行预防,以降低开颅术后颅内感染的发生。
[Abstract]:Objective to investigate the distribution of pathogenic bacteria and drug resistance of intracranial infection in patients after craniotomy in intensive care unit (ICU), and to analyze the related factors of infection so as to provide reference for clinical treatment. Methods 160 patients undergoing craniotomy in intensive care unit from January 2014 to June 2016 were selected and their clinical data were retrospectively analyzed to investigate their infection rate, distribution of pathogens and drug resistance. Multivariate Logistic regression analysis was used to analyze the risk factors of infection. Results among 160 patients undergoing craniotomy in intensive care unit, 12 cases had postoperative intracranial infection, and the infection rate was 7.5%. 22 strains of pathogenic bacteria were isolated from 12 cases, the most of which were Gram-negative bacteria (72.7%). Gram-positive bacteria accounted for 27.3%; The drug resistant rate of Acinetobacter baumannii was more than 50%: cefotaxime, ampicillin, aztreonam and levofloxacin, and the drug resistant rate of Klebsiella pneumoniae were ciprofloxacin, imipenem, amikacin and tobramycin. The drug resistant rate of Staphylococcus aureus was more than 50%: imipenem, erythromycin and levofloxacin. Multivariate Logistic regression analysis showed that the related factors of intracranial infection after craniotomy included history of diabetes, prolonged operation time, placement of drainage tube, cerebrospinal fluid leakage and low albumin level (P0.05). Conclusion the probability of intracranial infection in patients after craniotomy in intensive care unit is higher. The factors influencing intracranial infection after craniotomy include history of diabetes, prolonged operation time, placement of drainage tube, cerebrospinal fluid leakage and low albumin level. In order to reduce the incidence of intracranial infection after craniotomy, the related measures should be taken to prevent the above factors.
【作者单位】：嘉兴市第二医院ICU;
【基金】：浙江省医药卫生一般研究计划基金资助项目(2015KYB370)
【分类号】：R651.1

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