金黄色葡萄球菌导致的神经外科术后脑膜炎患者的死亡风险因素研究

Risk factors of mortality in patients with Staphylococcus aureus causing postoperative meningitis in neurosurgery

目的探讨金黄色葡萄球菌导致的神经外科术后脑膜炎(SAPM)患者的死亡风险因素。方法纳入2012年1月至2021年12月于首都医科大学附属北京天坛医院治疗的SAPM患者134例,回顾性分析了导致神经外科术后脑膜炎(PM)的细菌分布与金黄色葡萄球菌的耐药性,并对SAPM患者进行了多因素死亡风险因素分析确定感染死亡的风险因素,同时获得了SAPM患者结局的相关指标。结果导致PM的金黄色葡萄球菌中对青霉素的敏感率最低,耐甲氧西林金黄色葡萄球菌(MRSA)的比例高达40.7%。在134例患者中,有21例在住院期间死亡。单因素分析显示,经历二次手术(P=0.005),术后入住重症加强护理病房(ICU)(P=0.037),患者格拉斯哥昏迷评分(GCS)<8分(P=0.013),和MRSA感染(P=0.014)为SAPM患者死亡的相关因素(P<0.05)。多因素Logistic回归分析显示:患者感染MRSA(OR=3.501,95%CI:1.001~12.247,P=0.050)与术后GCS<8分(OR=16.072,95%CI:4.812~53.647,P<0.001)为SAPM患者死亡的独立风险因素。SAPM死亡患者的感染治疗时间(P<0.001)、治疗费用(P<0.001)显著高于非死亡患者,预防应用抗菌药物的比例也显著低于非死亡患者,差异有统计学意义(P=0.039)。结论SAPM是导致神经外科手术患者的重要并发症,MRSA感染与GCS<8分为SAPM患者独立的死亡风险因素,临床应予以注意。

Objective To explore the risk factors for mortality in patients with neurosurgical meningitis(SAPM)caused by Staphylococcus aureus.Methods A total of 134 patients with SAPM who were treated at Beijing Tiantan Hospital Affiliated to Capital Medical University from January 2012 to December 2021 were included.The bacterial distribution and resistance of Staphylococcus aureus causing postoperative meningitis(PM)in neurosurgery were retrospectively analyzed.Multivariate mortality risk factor analysis was performed on SAPM patients to determine the risk factors for infection death,and outcome related indicators of SAPM patients were obtained.Results Staphylococcus aureus,which caused PM in neurosurgery,had the lowest sensitivity to penicillin,with a high proportion of methicillin-resistant Staphylococcus aureus(MRSA)reaching 40.7%.Among 134 patients,21 cases died during hospitalization.Univariate analysis showed that having undergone a second surgery(P=0.005),being admitted to the Intensive Care Unit(ICU)after surgery(P=0.037),having a Glasgow Coma Scale(GCS)of less than 8 points(P=0.013),and MRSA infection(P=0.014)were related factors for mortality in SAPM patients(P<0.05).Multivariate Logistic regression analysis showed that infection with MRSA(OR=3.501,95%CI:1.001-12.247,P=0.050)and postoperative GCS<8(OR=16.072,95%CI:4.812-53.647,P<0.001)were independent risk factors for mortality in SAPM patients.The infection treatment time(P<0.001)and treatment cost(P<0.001)of SAPM death patients were significantly higher than those of non death patients,and the proportion of prophylactic use of antibiotics was also significantly lower than that of non death patients,with a statistically significant difference(P=0.039).Conclusion SAPM is an important complication that leads to neurosurgical surgery in patients.MRSA infection and GCS<8 are independent risk factors for mortality SAPM patients,and clinical attention should be paid to them.