摘要
目的根据新疆医科大学第一附属医院神经外科术后确诊为颅内感染的病例,分析脑脊液的病原体变迁及耐药情况,为临床工作提供早期诊疗方案。方法通过查阅该院在2016年1月—2020年12月行神经外科手术后诊断为颅内感染的病例,并由该院检验科获取这些病例中送检脑脊液培养结果为阳性的患者,回顾性分析入选患者的基本特征、脑脊液指标、病原体变迁以及耐药情况等数据。结果5年间共有8470例患者进行了神经外科相关手术,术后颅内感染587例,感染率为6.9%。脑脊液送检标本共培养出细菌76株,其中革兰阳性菌44株,革兰阴性菌32株。常见革兰阳性菌对万古霉素、利奈唑胺、替加环素的敏感率为100%,常见革兰阴性菌对替加环素的敏感率为100%。术后发生颅内感染的独立危险因素有:幕下病变、术后脑脊液漏、引流管放置时长(≥3 d)。结论神经外科术后颅内感染主要的致病微生物是凝固酶阴性葡萄球菌,对神经外科术后颅内感染不仅要做好术前预防、术中防范、术后护理,更需要早期识别,针对性使用抗生素。目前颅内感染的诊断和治疗仍需进一步深入研究。
Objective To analyze the changing pathogens and antibiotic resistance profile of neurosurgical postoperative intracranial infections based on the isolates from cerebrospinal fluid in the First Affiliated Hospital of Xinjiang Medical University for improving early diagnosis and treatment.Methods The patients with neurosurgical postoperative intracranial infection from January 2016 to December 2020 were reviewed retrospectively to identify the patients with pathogens isolated from cerebrospinal fluid.The clinical characteristics,cerebrospinal fluid tests,pathogens,and antimicrobial resistance data were summarized.Results A total of 8470 patients underwent neurosurgery-related operations during the 5-year period and 587 patients were diagnosed with intracranial infection.The incidence of infection was 6.9%.A total of 76 strains of bacteria were isolated from cerebrospinal fluid samples,including 44 strains of gram-positive bacteria and 32 strains of gram-negative bacteria.All of the common gram-positive bacteria were susceptible to vancomycin,linezolid and tigecycline.All of the common gram-negative bacteria were susceptible to tigecycline.Subtentorial lesion,postoperative leakage of cerebrospinal fluid,and duration of indwelling drainage tube(≥3 days)were independent risk factors for postoperative intracranial infection.Conclusions This study found that coagulase-negative Staphylococcus is the main pathogen of neurosurgical postoperative intracranial infection.In addition to preoperative prevention,intraoperative precautions,and postoperative care,early identification of pathogens and targeted antimicrobial therapy are also important for managing postoperative intracranial infections.
作者
张朝阳
吴金泽
冯妍
阿布都热合曼·阿卜拉
汪永新
王增亮
ZHANG Chaoyang;WU Jinze;FENG Yan;Abudureheman ABULA;WANG Yongxin;WANG Zengliang(Neurosurgery Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2022年第4期425-431,共7页
Chinese Journal of Infection and Chemotherapy
关键词
神经外科手术
颅内感染
病原体
耐药性
危险因素
neurosurgery
intracranial infection
pathogen
drug resistance
risk factor
