神经外科患者术后颅脑感染的病原学特点及高危因素分析

Analysis of the etiological characteristics of and risk factors a postoperative intracranial infection among patients in Neurosurgery

目的分析神经外科患者术后颅脑感染的病原学特点,并对病原菌的临床耐药情况及感染相关因素进行分析,为神经外科患者术后颅脑感染的防控提供科学指导。方法收集神经外科术后颅脑感染患者临床资料,从送检脑脊液标本中分离病原菌,采用全自动微生物鉴定仪进行菌株鉴定,采用K-B法分析病原菌的耐药性。结果 266例神经外科患者中,术后颅内感染80例,感染率30.08%。从80例感染患者脑脊液标本中共分离84株病原菌,其中革兰阳性菌53株,革兰阴性菌29株,真菌2株。革兰阳性菌中,凝固酶阴性葡萄球菌27株,金黄色葡萄球菌12株,粪肠球菌12株,其他4株;革兰阴性菌中,鲍曼不动杆菌16株,肺炎克雷伯菌6株,大肠埃希菌3株,铜绿假单胞菌2株,其他2株。凝固酶阴性葡萄球菌和金黄色葡萄球菌对环丙沙星、头孢他啶、头孢曲松、氯霉素和万古霉素的耐药率分别为33.33%、44.44%、40.74%、55.56%、0和33.33%、66.67%、58.33%、66.67%、0;粪肠球菌对环丙沙星、头孢他啶、头孢曲松、氯霉素、莫西沙星、加替沙星的耐药率分别为30.00%、50.00%、40.00%、60.00%、10.00%和10.00%。鲍曼不动杆菌和肺炎克雷伯菌对环丙沙星、头孢他啶、美罗培南、头孢曲松、氯霉素的耐药率分别为37.50%、50.00%、18.75%、43.75%、50.00%和33.33%、50.00%、0、50.00%、33.33%。年龄<60岁患者颅脑感染率为17.80%,≥60岁者为39.86%;有脑室外引流者感染率为47.78%,无脑室外引流者为21.20%;有脑脊液外漏者感染率为45.63%,无脑脊液外漏者为20.25%;术前使用抗生素者感染率为53.27%,术前未使用抗生素者为14.47%;感染率差异均有统计学意义(χ2=15.2040,20.2696,19.3411,45.7982,P均<0.05)。结论在神经外科患者术后颅脑感染的病原学特点分析中,病原菌类型以革兰阳性菌居多,其中又以凝固酶阴性葡萄球菌分离率最高,临床应高度重视此类病原菌的传播扩散。鉴于临床分离株的耐药程度,临床应合理选用抗菌药物,高效防治神经外科患者术后颅脑感染发生。神经外科患者年龄、脑室外引流、脑脊液外漏以及术前使用抗生素情况是发生颅脑感染的相关因素,临床应给予这些因素重视,并且对病原菌耐药性分析对治疗患者意义重大。

Objectives To analyze the etiological characteristics of a postoperative intracranial infection among patients in Neurosurgery and to study the drug resistance of pathogenic bacteria in clinical settings and factors related to infection in order to scientifically guide the prevention and control of postoperative intracranial infections among patients in Neurosurgery. Methods Clinical data on patients with a postoperative intracranial infection in Neurosurgery were collected and pathogenic bacteria were isolated from those patients.The strains were identified by an automated microbial analyzer,and drug resistance was analyzed using the K-B method. Results Of 266 patients in Neurosurgery,80 had a postoperative intracranial infection for a rate of infection of 30.08%.Eighty-four strains of pathogenic bacteria were isolated from cerebrospinal fluid specimens from 80 patients with an infection,including 53 strains of Gram-positive bacteria,29 strains of Gram-negative bacteria,and 2strains of fungi.The Gram-positive bacteria included 27 strains of coagulase-negative Staphylococci,12 strains of Staphylococcus aureus,12 strains of Enterococcus faecalis,and 4strains of other bacteria.The Gram-negative bacteria included 16 strains of Acinetobacter baumannii,6strains of Klebsiella pneumoniae,3strains of Escherichia coli,2strains of Pseudomonas aeruginosa,and 2strains of other bacteria.Resistance of coagulase-negative Staphylococci to ciprofloxacin was 33.33%,their resistance to ceftazidime was 44.44%,their resistance to ceftriaxone was 40.74%,their resistance to chloramphenicol was 55.56%,and their resistance to vancomycin was 0%.Resistance of S.aureus to ciprofloxacin was 33.33%,its resistance to ceftazidime was 66.67%,its resistance to ceftriaxone was 58.33%,its resistance to chloramphenicol was 66.67%,and its resistance to vancomycin was 0%.Resistance of E.faecalis to ciprofloxacin was 30.00%,its resistance to ceftazidime was 50.00%,its resistance to ceftriaxone was40.00%,its resistance to chloramphenicol was 60.00%,its resistance to moxifloxacin was 10.00%,and its resistance to gatifloxacin was 10.00%.Resistance of A.baumannii to ciprofloxacin was 37.50%,its resistance to ceftazidime was50.00%,its resistance to meropenem was 18.75%,its resistance to ceftriaxone was 43.75%,and its resistance to chloramphenicol was 50.00%.Resistance of K.pneumoniae to ciprofloxacin was 33.33%,its resistance to ceftazidime was50.00%,its resistance to meropenem was 0%,its resistance to ceftriaxone was 50.00%,and its resistance to chloramphenicol was 33.33%.The rate of an intracranial infection among patients under the age of 60 was 17.80%,and the rate of intracranial infection among patients over the age of 60 was 39.86%.The rate of infection among patients with external ventricular drainage was 47.78%,and the rate of infection among patients without external ventricular drainage was21.20%.The rate of infection among patients with cerebrospinal fluid leakage was 45.63%,and the rate of infection among patients without cerebrospinal fluid leakage was 20.25%.The rate of infection among patients receiving antibiotics before surgery was 53.27%,and the rate of infection among patients not receiving antibiotics before surgery was14.47%.Differences in the rate of infection were statistically significant（χ2=15.2040,20.2696,19.3411,45.7982,P〈0.05）. Conclusion Analysis of the etiological characteristics of postoperative intracranial infections among patients in Neurosurgery indicated that pathogenic bacteria were primarily Gram-positive bacteria.The Gram-positive bacteria that were isolated most often were coagulase-negative Staphylococci,and transmission and spread of the pathogenic bacteria should be closely monitored in clinical settings.In light of the drug resistance of clinical isolates,antibacterials should be chosen rationally to effectively prevent and treat postoperative intracranial infections among patients in Neurosurgery.Age,external ventricular drainage,cerebrospinal fluid leakage,and receipt of antibiotics before surgery were factors related to the development of a postoperative intracranial infection.Attention should be paid to these factors,and analysis of the drug resistance of pathogenic bacteria is crucial to patient treatment.