颅脑外伤患者继发医院颅内感染的病原学分析及脑电图监测

Etiological analysis and EEG monitoring of hospital-acquired intracranial infection secondary to brain trauma

目的探讨颅脑外伤患者继发医院颅内感染的病原学因素,总结脑电图监测意义,以期降低感染率,控制病情进展。方法回顾性分析2009—2013年1 031例颅脑外伤患者,对其中59例颅内感染者从病原菌分布、细菌耐药等方面进行总结,观察脑电图的临床价值。结果59例感染中分离出病原菌71株,其中革兰阴性菌占59.15%,革兰阳性菌占35.21%,真菌占5.64%;主要以铜绿假单胞菌、大肠埃希菌、金黄色葡萄球菌、肺炎克雷伯菌等为主;在耐药性上,革兰阴性菌中耐药性较低的抗菌药物有利奈唑胺、亚胺培南,余抗生素耐药性均在11.76%以上。而在革兰阳性菌中耐药性较低的抗生素为替考拉宁、万古霉素,余均在16.67%以上。脑电图上,治疗2周后颅内感染检出率为55.66%。结论颅脑外伤继发医院颅内感染以革兰阴性菌为主,脑电图有助于防治感染。

Objective To analyze the etiology of hospital‐acquired intracranial infection secondary to brain trauma and summarize the significance of EEG monitoring in order to reduce infection rates and control progression .Methods 1 031 cases with brain trauma from 2009 to 2013 in our hospital were analyzed retrospectively ,of which 59 cases complicated with hospital‐acquired intracranial infection were summarized in terms of bacteria distribution and drug resistance ,and the value of EEG was observed .Results In 59 infectious cases ,we isolated 71 pathogens including Gram‐negative bacteria（59 .15% ） ,Gram‐positive bacteria（35 .21% ） ,fungi（5 .64% ）;and the major bacteria were pseudomonas aeruginosa ,Escherichia coli ,Staphylococcus au‐reus aureus ,Klebsiella pneumoniae .In the aspect of drug resistance ,the resistance rate of antimicrobial drugs was more than 11 .76% except for linezolid and imipenem in gram‐negative bacteria .Apart from teicoplanin and vancomycin ,the resistance rate of antimicrobial drugs was more than 16 .67% in Gram‐positive bacteria .After the treatment ,the detection rate of in‐tracranial infection was 55 .66% by EEG .Conclusion Gram‐negative bacteria remains the most prevalent microbe in patients with hospital‐acquired intracranial infection secondary to brain trauma ,EEG can help against infection .