颅脑外伤患者术后中枢神经系统感染的危险因素及病原菌特点分析

Risk factors and characteristics of pathogenic bacterias of infections of the central nervous system in patients after neurosurgery craniotomy with craniocerebral trauma

目的明确颅脑外伤患者术后发生颅内感染的危险因素、病原菌的分布特点及耐药性分析。方法回顾性分析2016年1月至2022年12月在首都医科大学附属北京天坛医院神经外科行手术治疗的颅脑外伤患者的临床资料,依据术后是否发生中枢神经系统感染分为感染组(335例)和非感染组(770例)。分析导致术后中枢神经系统感染发生的危险因素;通过分析感染组患者脑脊液的细菌培养及鉴定结果,了解病原菌的分布特点及耐药性。结果手术持续时间≥3 h、术中出血量≥400 mL、二次手术、有切口脑脊液漏、引流管留置时间≥3 d、重症监护室(ICU)滞留时间≥7 d、合并糖尿病、血清降钙素原升高、快速C反应蛋白升高是发生术后中枢神经系统感染的危险因素(P<0.05)。脑脊液送检标本共培养出细菌107株,其中革兰阳性菌46株,革兰阴性菌61株。常见革兰阳性菌对万古霉素、利奈唑胺、替加环素均敏感,革兰阴性菌大多为多重耐药菌。结论手术持续时间长、术中出血量大、再次手术、有切口脑脊液漏、引流管留置时间长、ICU滞留时间长、合并糖尿病是颅脑外伤患者术后中枢神经系统感染的危险因素,需注意对相关危险因素进行防控,尽可能减少术后中枢神经系统感染事件的发生。此外革兰阴性菌感染比率逐渐上升,应根据细菌培养结果及时调整抗菌药物使用,制定更有针对性的抗感染治疗方案。

Objective To clarify the risk factors,distribution characteristics of pathogenic bacteria,and drug resistance of postoperative intracranial infections in patients with craniocerebral trauma.Methods Retrospective analysis of clinical data of patients with traumatic brain injury who underwent surgical treatment at Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from January 2016 to December 2022.According to whether central nervous system infection occurred after surgery,the patients were divided into the infection group(335 cases) and the non infection group(770 cases).The risk factors leading to postoperative central nervous system infections were analyzed.The bacterial culture and identification results of cerebrospinal fluid in infected patients were analyzed,and the distribution characteristics and drug resistance of pathogens were understood.Results Operation duration≥3 h,intraoperative bleeding≥400 mL,secondary operation,cerebrospinal fluid leakage with incision,drainage tube retention time≥3 days,intensive care unit(ICU) retention time≥7 days,diabetes,and the increase of serum procalcitonin and C-reactive protein were risk factors for postoperative infections of the central nervous system(P<0.05).A total of 107 bacterial strains were cultured from cerebrospinal fluid samples,including 46 Gram positive bacteria and 61 Gram negative bacteria.Common gram-positive bacteria were sensitive to Vancomycin,Linezolid and Tigecycline,and most gram-negative bacteria were multidrug resistant.Conclusion Long operation duration,large intraoperative bleeding,reoperation,cerebrospinal fluid leakage with incision,long retention time of drainage tube,long retention time in ICU,and diabetes are risk factors for infections of the central nervous system after craniocerebral trauma.Attention should be paid to the control of relevant risk factors to minimize the occurrence of infections of the central nervous system after surgery.In addition,the infection rate of Gram-negative bacteria is gradually rising.The use of antibiotics should be adjusted in time according to the results of bacterial culture,and a more targeted anti infection program should be developed.