颅脑外伤患者开颅术后颅内感染的相关因素与耐药性分析

Related factors for postoperative intracranial infections in craniocerebral trauma patients undergoing craniotomy and drug resistance

目的分析颅脑外伤患者开颅术后颅内感染的相关因素与耐药性,为临床预防提供依据。方法回顾性分析2012年1月-2015年7月宁波市第二医院收治的230例行开颅手术颅脑外伤患者临床资料,探讨颅脑外伤患者开颅术后发生颅内感染的相关因素,并对感染患者进行病原菌培养,分析其耐药性。结果 230例颅脑外伤患者术后发生颅内感染24例,感染率10.43%;24例颅内感染患者脑脊液培养出病原菌24株,其中革兰阳性菌15株占62.50%,革兰阳性菌9株占37.50%;革兰阳性菌对苯唑西林与青霉素的耐药率均较高,分别为93.33%、86.67%,对万古霉素耐药率较低;革兰阴性菌对卡那霉素的耐药率最高,为55.56%;经单因素分析,影响颅脑外伤患者开颅手术后发生颅内感染的相关因素包括手术持续时间、手术次数、手术入路方式、术后切口脑脊液漏、脑室外引流及术后低蛋白血症等(P<0.05);经多因素logistic回归分析显示,颅脑外伤患者手术时间、手术次数、切口脑脊液漏、脑室外引流是术后发生颅内感染的独立危险因素。结论颅脑外伤患者开颅手术后发生颅内感染由多种因素造成,临床上确诊应依据药敏检查结果,及时调整抗菌药物进行治疗,以尽快控制感染。

OBJECTIVE To investigate the related factors for postoperative intracranial infections in the craniocerebral trauma patients undergoing craniotomy and analyze the drug resistance so as to provide guidance for clinical prevention.METHODS The clinical data were collected from 230 patients with craniocerebral trauma who underwent the craniotomy in the Second Hospital of Ningbo City from Jan 2012 to Jul 2015 and were retrospectively analyzed,the related factors for the postoperative intracranial infections in the patients were explored,the bacterial culture was carried out for the patients with infections,and the drug resistance was analyzed.RESULTS Of the 230 craniocerebral trauma patients,24 had the postoperative intracranial infections with the infection rate of 10.43%.A total of 24 strains of pathogens were cultured from cerebrospinal fluid specimens obtained from the 24 patients with intracranial infections,including 15（62.50%）strains of gram-positive bacteria and 9（37.50%）strains of gram-positive bacteria.The drug resistance rate of the gram-positive bacteria to oxacillin and penicillin were93.33%and 86.67%,respectively;the drug resistance rate to vancomycin was relatively low.The drug resistance rate of the gram-negative bacteria to kanamycin was the highest（55.56%）.The univariate analysis indicated that the related factors for the postoperative intracranial infections in the craniocerebral trauma patients undergoing craniotomy included the operation duration,number of times of surgery,surgical approach,postoperative incision of cerebrospinal fluid leakage,external ventricular drainage,and postoperative hypoproteinemia（P〈0.05）.The multivariate logistic regression analysis showed that the independent risk factors for the postoperative intracranial infections included the operation duration,number of times of surgery,incision of cerebrospinal fluid leakage,and external ventricular drainage.CONCLUSION There are a variety of factors that result in the postoperative intracranial infections in the patients with craniocerebral trauma undergoing craniotomy.It is necessary for the hospital to make confirmed diagnosis and adjust the drug therapy based on results of the drug susceptibility testing so as to control the infections in a timely manner.