开颅手术患者术后颅内感染病原学特点及危险因素分析

发布时间：2019-08-03 06:41

【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(P0.05)。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。
[Abstract]:Objective to investigate the etiological characteristics and risk factors of intracranial infection in patients undergoing craniotomy. Methods 479 patients undergoing craniotomy from May 2010 to May 2017 were selected. The clinical data of the patients were analyzed retrospectively. cerebrospinal fluid (cerebrospinal fluid) was collected by lumbar puncture to identify pathogenic bacteria and analyze the risk factors of infection. Results there were 59 cases of intracranial infection after craniotomy, the infection rate was 12.32%, 70 strains of pathogenic bacteria were isolated and cultured, including 45 strains of Gram-negative bacteria (64.29%), 23 strains of Gram-positive bacteria (32.86%), 2 strains of fungi (2.86%), and the resistance rates of Acinetobacter baumannii to amikacin and aztreonam were 95.65% and 86.96%, respectively, and the resistance rates of Acinetobacter baumannii to amikacin and aztreonam were 95.65% and 86.96%, respectively. Pseudomonas aeruginosa was resistant to ceftazidime and amikacin, Staphylococcus aureus was resistant to penicillin and erythromycin, penicillin, erythromycin and levofloxacin were 100.00%, 85.71% and 85.71%, respectively. the resistance rates of Pseudomonas aeruginosa to ceftazidime and amikacin, Staphylococcus aureus and penicillin, erythromycin and levofloxacin were 100.00%, 85.71% and 85.71%, respectively, and the resistance rates of Pseudomonas aeruginosa to penicillin, erythromycin and levofloxacin were 100.00%, 85.71% and 85.71%, respectively. The time of operation, cerebrospinal fluid leakage, prophylactic use of antibiotics and placement of drainage tube were independent risk factors for postoperative intracranial infection (P 0.05). Conclusion Gram-negative bacteria are the main pathogens in postoperative intracranial infection. Antibiotics should be used reasonably according to the characteristics of pathogenic bacteria and drug resistance analysis, and the corresponding countermeasures should be taken according to independent risk factors to reduce the incidence of postoperative intracranial infection.
【作者单位】：浙江大学医学院附属二院建德分院脑外科;
【基金】：浙江省医药卫生一般研究计划基金资助项目(2015KYA106)
【分类号】：R651.1

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