脑出血患者血肿穿刺引流术后颅内感染的病原菌特点及危险因素

Pathogens characteristics and risk factors for intracranial infection of patients with cerebral hemorrhage after hematoma puncture and drainage surgery

目的分析脑出血患者血肿穿刺引流术后颅内感染的病原菌特点及危险因素。方法选取276例行血肿穿刺引流术治疗的脑出血患者,记录其术后1周内颅内感染的发生情况。分析颅内感染患者脑脊液病原菌的分布特点及主要病原菌的耐药率。采用多因素Logistic回归模型分析脑出血患者术后发生颅内感染的影响因素。根据多因素Logistic回归分析结果构建诊断模型,通过绘制受试者工作特征(ROC)曲线评估诊断模型对脑出血患者术后发生颅内感染的诊断价值。结果276例脑出血患者血肿穿刺引流术后1周内颅内感染的发生率为16.30%(45/276)。45份脑脊液标本共检出病原菌52株,主要为革兰阳性菌(占63.46%);主要的革兰阳性菌对阿莫西林、青霉素、红霉素、克林霉素的耐药率均高于80.00%,对万古霉素均无耐药。多因素Logistic回归分析结果显示,年龄、术前血清白蛋白水平、引流管留置时间、术中尿激酶使用次数、术后发生脑脊液漏及合并糖尿病均与脑出血患者术后发生颅内感染有关(均P<0.05)。诊断模型为logit(P)=-1.636+0.698×年龄-0.821×术前血清白蛋白水平+1.214×引流管留置时间+1.009×术中尿激酶使用次数+1.315×术后发生脑脊液漏+1.663×合并糖尿病,ROC曲线分析结果显示该诊断模型诊断脑出血患者术后发生颅内感染的曲线下面积为0.852,敏感度为91.11%,特异度为55.84%。结论脑出血患者血肿穿刺引流术后颅内感染的最常见病原菌为革兰阳性菌,且对常用抗菌药物的耐药率较高。此类患者术后发生颅内感染受年龄、术前血清白蛋白水平、术中输注尿激酶次数、引流管留置时间、术后脑脊液漏、合并糖尿病的影响。

Objective To analyze the pathogens characteristics and risk factors for intracranial infection of patients with cerebral hemorrhage after hematoma puncture and drainage surgery.Methods A total of 276 patients with cerebral hemorrhage undergoing hematoma puncture and drainage surgery were selected.The occurrence of intracranial infection in patients within 1 week after operation was recorded.The distribution characteristics of cerebrospinal fluid pathogens and resistance rates of major pathogens in patients with intracranial infection were analyzed.The influencing factors for the occurrence of intracranial infection in patients with cerebral hemorrhage after surgery were analyzed by employing multivariate Logistic regression model.The diagnostic model was established according to the results of multivariate Logistic regression analysis.The diagnostic value of the diagnostic model on the occurrence of intracranial infection in patients with cerebral hemorrhage after surgery was evaluated by drawing receiver operating characteristic(ROC)curve.Results The incidence rate of intracranial infection among 276 patients with cerebral hemorrhage within 1 week after hematoma puncture and drainage surgery was 16.30%(45/276).A total of 52 pathogens were detected from 45 cerebrospinal fluid samples,which were mainly Gram-positive bacteria(accounting for 63.46%).The resistance rates of main Gram-positive bacteria to amoxicillin,penicillin,erythromycin,and clindamycin were higher than 80.00%,and there was no resistance to vancomycin.The results of multivariate Logistic regression analysis revealed that age,preoperative serum albumin level,indwelling time of drainage tube,times of intraoperative urokinase use,postoperative occurrence of cerebrospinal fluid leakage,and concomitant diabetes mellitus were related to the occurrence of intracranial infection in patients with cerebral hemorrhage after surgery(all P<0.05).The diagnostic model was logit(P)=-1.636+0.698×age-0.821×preoperative serum albumin level+1.214×indwelling time of drainage tube+1.009×times of intraoperative urokinase use+1.315×postoperative occurrence of cerebrospinal fluid leakage+1.663×concomitant diabetes mellitus.The results of ROC curve analysis indicated that the area under the curve of this diagnostic model for diagnosing the occurrence of intracranial infection in patients with cerebral hemorrhage after surgery was 0.852,and the sensitivity was 91.11%,as well as the specificity was 55.84%.Conclusion The most common pathogen of intracranial infection in patients with cerebral hemorrhage after hematoma puncture and drainage surgery is Gram-positive bacteria,and the resistance rate to common antibacterial medicines is relatively high.The occurrence of intracranial infection in these patients after surgery is affected by age,preoperative serum albumin level,times of intraoperative urokinase use,indwelling time of drainage tube,postoperative cerebrospinal fluid leakage,and concomitant diabetes mellitus.