某医院神经外科开颅术后颅内感染目标性监测分析

Analysis of targeted monitoring of intracranial infection after craniotomy in neurosurgery department of a hospital

目的了解神经外科开颅术后颅内感染现状,查找感染原因。方法收集2016—2018年某医院神经外科开颅手术的相关资料,就颅内感染率、发病时间、病原菌、药敏结果及影响因素进行目标性监测分析。结果3306例开颅手术中颅内感染率5.35%;夏季最高,其次秋季,冬春季较低;177例颅内感染术后3~14 d发病的占70.05%,检出病原菌83株,其中革兰阴性菌占62.65%;鲍曼不动杆菌仅对替加环素及阿米卡星的敏感率>50%;铜绿假单胞菌对氨曲南及亚胺培南的敏感率<30%;金黄色葡萄球菌及表皮葡萄球菌对苯唑西林的耐药率分别为33.33%和71.43%;多因素Logistic分析显示,手术等级、手术时间>4 h、留置引流管及脑脊液漏为颅内感染的影响因素。结论神经外科开颅术后颅内感染率较高,术后3~14 d为高发期,病原菌以革兰阴性菌为主,对常用抗菌药物耐药性严重,应加强相关影响因素的监测防控。

Objective To understand the current situation of intracranial infection after craniotomy in neurosurgery department.Methods The related data of craniotomy was collected in neurosurgery department of a hospital from 2016 to 2018,and the intracranial infection rate,onset time,pathogenic bacteria,drug sensitivity results and influencing factors were monitored and analyzed.Results In 3306 cases of craniotomy,the intracranial infection rate was 5.35%;it was the highest in summer,followed by autumn,and lower in winter and spring.177 cases of intracranial infection occurred within 3 to 14 d after operation,accounting for 70.05%.83 strains of pathogenic bacteria were detected,of which 62.65%were Gram-negative bacteria.The sensitivity rate of Acinetobacter baumanniito tigecycline and amikacin was>50%;the sensitivity rate of Pseudomonas aeruginosato aztreonam and imipenem was<30%;the resistance rates of Staphylococcus aureus and Staphylococcus epidermidisto oxacillin were 33.33%and 71.43%,respectively.Multivariate Logistic analysis showed that operation grade,operation time>4 h,indwelling drainage tube and cerebrospinal fluid leakage were the influencing factors of intracranial infection.Conclusion The intracranial infection rate was higher after craniotomy in neurosurgery department.The high-incidence period was 3 to 14 d after surgery.The Gram-negative bacteria were mainly pathogenic bacteria,and they were highly resistant to commonly used antibacterial drugs.It is necessary to strengthen the monitoring and prevention and control of relevant influencing factors.