开颅手术患者颅内感染病原菌监测分析

Monitoring of pathogenic bacteria causing intracranial infections in patients undergoing craniotomy

目的对开颅手术后患者颅内感染病例进行目标性监测分析,为控制感染提供依据。方法采用前瞻性监测与回顾性分析相结合的方法,应用医院感染实时监测预警系统对颅内感染病原菌检出情况及耐药性进行统计分析。结果共监测开颅手术3 589例,发生颅内感染103例,感染率2.87%,其中漏报9例,漏报率8.7%;共检出病原菌91株,其中革兰阴性杆菌67株占73.6%,革兰阳性菌22株占24.2%,真菌2株占2.2%;排名前5位的病原菌依次为鲍氏不动杆菌、表皮葡萄球菌、嗜麦芽寡养单胞菌、大肠埃希菌、金黄色葡萄球菌,分别占26.4%、12.1%、7.7%、5.5%、5.5%;革兰阴性杆菌对三代头孢菌素耐药性高,仅对多黏菌素B、米诺环素、头孢哌酮/舒巴坦敏感,葡萄球菌属对万古霉素、米诺环素、呋喃妥因100.0%敏感,对利福平、苯唑西林、亚胺培南、庆大霉素耐药率较低。结论革兰阴性杆菌为颅内感染主要病原菌,耐药性高,需采取有效干预措施,控制医院感染。

OBJECTIVE To perform a targeted analysis of the cases of intracranial infections after craniotomy so as to provide guidance for the control of infections. METHODS By means of prospective monitoring combined with retrospective analysis, the isolation rates of pathogens causing the intracranial infections and the drug resistance were statistically analyzed with the use of real-time monitoring and warning system. RESULTS Of 3589 cases of craniotomy under the targeted monitoring, the intracranial infections occurred in 103 cases with the infection rate of 2.87%, among which 9 cases were failed to report with the missing report rate of 8.7%. Totally 91 strains of pathogens have been isolated, including 67 （73.6%） strains of gram-negative bacilli, 22 （24.2%） strains of gram- positive bacteria, and 2 （2.2%） strains of fungi l the Acinetobacter baumannii, Staphylococcus epidermidis, Stenotrophomonas maltophilia, Escherichia coli, and Staphylococcus aureus ranked the top 5 species of patho- gens, accounting for 26.4%, 12.1%, 7.7%, 5.5%, and 5.5%, respectively. The gram-negative bacilli were highly resistant to the third generation cephalosporin and were only susceptible to polymyxin B, minocyeline, and cefoperazone-sulbactam; the drug susceptibility rates of the Staphylococcus spp to vancomycin, minocycline, and nitrofurantoin were 100.0%, and the drug resistance rates to rifampin, oxacillin, imipenem, and gentamicin were relatively low. CONCLUSION The gram-negative bacilli are dominant among the pathogens causing intracranial in- fections and are highly drug resistant, and the effective intervention measures should be taken so as to control the nosocomial infections.