颅脑损伤术后中枢神经系统感染病原菌及危险因素

Etiological characteristics and risk factors for postoperative central nervous system infection in craniocerebral injury patients

目的分析颅脑损伤术后中枢神经系统感染病原菌及危险因素。方法回顾性选取630例2018年1月-2022年12月青岛大学附属青岛市海慈医院收治的行颅脑手术患者为研究对象,统计术后并发中枢神经系统感染现况及病原菌分布,单因素及多因素Logistic回归分析法分析颅脑损伤术后并发中枢神经系统感染的危险因素。结果630例颅脑损伤患者术后并发中枢神经系统感染35例,感染率为5.56%;共培养病原菌37株,其中革兰阳性菌20株,占54.05%,主要为凝固酶阴性葡萄球菌;革兰阴性菌16株,占43.24%,主要为鲍氏不动杆菌;真菌1株,占2.70%;手术时间≥4 h、疾病类型为开放伤、合并糖尿病、脑室留置引流管、伴脑脊液漏是颅脑损伤术后中枢神经系统感染的独立危险因素(OR=2.212;2.284;2.121;2.071;2.259,P<0.05)。结论颅脑损伤术后中枢神经系统感染率较高,检出的病原菌以凝固酶阴性葡萄球菌和鲍氏不动杆菌为主,危险因素包括手术时间≥4 h、疾病类型为开放伤、合并糖尿病、脑室留置引流管及伴脑脊液漏,临床可针对危险因素进行预防以降低颅脑损伤术后并发中枢神经系统感染的发生风险。

OBJECTIVE To investigate the etiological characteristics and risk factors for the postoperative central nervous system infection in the patients with craniocerebral injury.METHODS A total of 630 patients who underwent craniocerebral surgery in Qingdao Haici Hospital Affiliated to Qingdao University from Jan 2018 to Dec 2022 were retrospectively recruited as the research subjects.The prevalence of postoperative central nervous system infection and distribution of pathogens were statistically analyzed.Univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the postoperative central nervous system infection in the patients with craniocerebral injury.RESULTS Among the 630 patients with craniocerebral injuries,35 had postoperative central nervous system infection,with the infection rate 5.56%.Totally 37 strains of pathogens were isolated,20(54.05%)of which were gram-positive bacteria,16(43.24%)were gram-negative bacteria,1(2.70%)was fungus;coagulase-negative Staphylococcus was dominant among the gram-positive bacteria,Acinetobacter baumannii was the predominant species of the gram-negative bacteria.The operation duration no less than 4 hours,open injury,complication with diabetes mellitus,intraventricular drainage tube indwelling and leakage of cerebrospinal fluid were the independent risk factors for the postoperative central nervous system infection in the patients with craniocerebral injuries(OR=2.212;2.284;2.121;2.071;2.259,P<0.05).CONCLUSION The incidence of postoperative central nervous system infection is high among the patients with craniocerebral injuries.Coagulase-negative Staphylococcus and A.baumannii are dominant among the isolated pathogens.The risk factors include the operation duration no less than 4 hours,open injury,complication with diabetes mellitus,intraventricular drainage tube indwelling and leakage of cerebrospinal fluid.It is necessary for the hospital to take prevention measures based on the risk factors so as to reduce the risk of postoperative central nervous system infection.