颅脑手术患者鼻前庭及口咽部定植菌与术后医院感染的关系

Relationship of colonization bacteria of nasal vestibule and oropharynx with postoperative hospital infections in patients undergoing brain surgery

目的探讨颅脑手术患者鼻前庭、口咽部定植菌与术后医院感染的关系。方法 200例接受颅脑手术患者,于入院时采集鼻前庭、口咽部拭子,测定其定植菌,对术后发生医院感染的患者采集相应感染部位的标本并行培养及鉴定,分析术后医院感染与定植菌的关系。结果 200例颅脑手术患者中,鼻前庭、口咽部检出条件致病菌各95株、36株。鼻前庭检出条件致病菌定植的患者医院感染率为50.53%,高于未检出条件致病菌的患者(31.43%)(P<0.05)。口咽部检出条件致病菌定植的患者医院感染率为61.11%,高于未检出条件致病菌的患者(35.98%)(P<0.05)。与医院感染相关的条件致病定植菌有25株(19.08%),其中鼻前庭19株,口咽部6株,两者比较差异无统计学意义(P>0.05)。鼻前庭19株条件致病菌中,以金黄色葡萄球菌最常见,其次为肺炎克雷伯菌;口咽部6株条件致病菌以肺炎克雷伯菌为主。定植菌相关感染的部位分布为肺部20例、颅内3例、泌尿道2例,以肺部感染率最高(P<0.001)。结论颅脑手术患者鼻前庭、口咽部定植菌与医院感染有一定关联,与肺部感染的关系密切;施行颅脑手术患者在术前应行鼻前庭、口咽部清洁,减少医院感染的发生。

Objective To investigate the relationship of colonization bacteria of nasal vestibule and orophaynx with postoperative hospital infection in patients undergoing brain surgery. Methods Two hundred patients undergoing brain surgery were enrolled in the study. The swabs were collected from nasal vestibule and oropharynx of the patients after admission,and the colonization bacteria were detected.For the patients with postoperative hospital infection,the samples were collected from related infected sites for culture and identification. And the relationship between postoperative hospital infection and colonization bacteria was analyzed. Results In 200 patients undergoing brain surgery,opportunistic pathogens detected from nasal vestibule and orophaynx amounted to 95 strains and 36 strains,respectively. The hospital infection rate in patients with opportunistic pathogens in nasal vestibule colonization was higher than that in patients without opportunistic pathogens colonization in nasal vestibule（ 50. 53% vs. 31. 43%,P〈0. 05）. The hospital infection rate in patients with opportunistic pathogens colonization in oropharynx was higher than that in patients without opportunistic pathogens colonization in oropharynx（ 61. 11% vs. 35. 98%,P〈0. 05）. There were 25strains（ 19. 08%） of opportunistic colonization bacterial correlated with hospital infection including 19 strains from nasal vestibule and 6strains from oropharynx,and there was no statistical difference in the number between the two sites（ P〉0. 05）. Of 19 opportunistic pathogens in nasal vestibule,Staphylococcus aureus was the most common,and Klebsiellarpneumonia was the second one. And most of the6 opportunistic pathogens in oropharynx were Klebsiellarpneumonia. The sites with colonization bacteria-related infection consisted of lung（ n = 20）,intracalvarium（ n = 3） and urinary tract（ n = 2）,and the lung infection was the most common（ P〈0. 001）. Conclusion For patients undergoing brain surgery,colonization bacteria in nasal vestibule and oropharynx have a certain relationship with hospital infection,and closely correlate with lung infection. It is suggested that the cleaning for nasal vestibule and orophaynx should be performed preoperatively in patients undergoing brain surgery so as to decrease the incidence of hospital infection.