预防性应用抗生素对清洁开颅手术术后感染率的影响

The efficacy of antibiotic prophylaxis in clean and scheduled craniotomy: a retrospective study

目的回顾性分析预防性应用抗生素对清洁开颅手术术后感染率的影响,同时探讨影响术后感染的危险因素。方法选取天津市环湖医院神经外科2009年1月至2014年12月6年间所有择期手术,Ⅰ类切口开颅手术病例,2009年1月至2011年11月期间所有手术均预防性应用抗生素(AP),2011年12月至2014年12月期间所有手术均未预防性应用抗生素(n-AP),对比分析AP对术后感染率的影响;应用Logistic回归分析术后感染的危险因素。结果 579例手术纳入研究。AP组250例,感染23例;n-AP组329例,感染30例,两组感染率无统计学差异(χ~2=0.01,P=0.973)。术后感染脑脊液细菌培养阳性率AP组27.3%,n-AP组59.3%,两组脑脊液培养阳性率存在显著统计学差异(χ2=5.01,P=0.025)。术后脑脊液漏(OR:38.4,95%CI:10.03~146.58),手术时间(OR:1.12,95%CI:1.01~1.25)为术后感染危险因素。结论择期手术,Ⅰ类切口开颅手术预防性应用抗生素并没有降低术后感染率,反而降低脑脊液细菌培养阳性率。术后液漏和手术时间是术后感染的危险因素。

Objective The effect of antibiotic prophylaxis （AP） on the rate of post-operative infection in craniotomy was discussed and the risk factors for the infection were studied. Methods The clean and scheduled craniotomy cases which had undergone surgery in the 8th Depamnent of Neurosurgery in Tianjin Huanhu Hospital during 6 years were collected. For the cases treated from January 2009 to November 2011, antibiotic prophylaxis was prescribed for all surgeries. For cases from November 2011 to December 2014, no antibiotic prophylaxis （n-AP） was administered to all patients. The infection rate of two groups after surgery was analyzed. Additionally, independent risk factors for infection were investigated using Logistic regression analysis. Results A total of 579 cases were enrolled in the study including 250 cases with 23 infection cases in AP group, and 329 cases with 30 infection cases in n-AP group. There was no statistically significant difference between two groups in infection rate （x^2 = 0. 01, P=0.973）. The positive rates of bacterial culture were 27.3% in the AP group compared to 59.3% in the n-AP group. The rate did differ significantly between two groups （x^2 =5.01, P =0.025）. CSF leakage （OR： 38. 4, 95% CI： 10. 03 - 146. 58） and surgery time （OR： 1.12, 95% CI： 1. 01 - 1.25） were the independent risk factors for postoperative infection in the Logistic regression model. Conclusion Antibiotic prophylaxis can not reduce the rate of post-operative infection in clean and scheduled craniotomy. Additionally, AP appears to reduce the positive rate of bacterial culture. The independent risk factors for post-operative infection are CSF leakage and surgery time.