神经外科开颅手术患者术后颅内感染病原菌分布与治疗  

Distribution of pathogens causing postoperative intracranial infections in neurosurgery department patients undergoing craniotomy and treatment measures

作　　者：郭孝龙[1,2] 周江朝[2] 乔鹏[2] 武宏杰[2] 宋来君[1] 

机构地区：[1]郑州大学第一附属医院神经外科,河南郑州450052 [2]河南科技大学第一附属医院神经外科,河南洛阳471000

出　　处：《中华医院感染学杂志》2015年第22期5109-5111,共3页Chinese Journal of Nosocomiology

基　　金：河南省高等学校重点科硏基金资助项目(15A320055)

摘　　要：目的探讨神经外科开颅手术患者术后颅内感染病原菌分布特征及治疗措施,为颅内感染的防治提供依据。方法回顾性分析2008年1月-2015年6月在医院神经外科行开颅手术的1 500例患者临床资料,分析患者颅内感染率及病原菌特征;对颅内感染患者给予抗菌药物脑室内灌洗或鞘内灌洗,比较两种给药方式的疗效。结果 1 500例开颅手术患者术后颅内感染50例,颅内感染率3.3%;感染患者脑脊液中分离出73株病原菌,其中革兰阳性菌45株占61.6%,革兰阴性菌25株占34.3%,真菌3株占4.1%;金黄色葡萄球菌对红霉素耐药率为100.0%,对青霉素耐药率为90.5%,对利奈唑胺、哌拉西林/他唑巴坦、万古霉素耐药率均为0;肺炎克雷伯菌对氨曲南耐药率为100.0%,对亚胺培南耐药率为0;鞘内灌洗组总有效率为73.9%、脑室内灌洗组为96.3%,脑室内灌洗组总有效率显著高于鞘内灌洗组,差异有统计学意义(χ2=5.168,P<0.05)。结论颅内感染脑脊液病原菌感染革兰阳性菌居首位,脑室内灌洗对颅内感染患者的疗效显著优于鞘内灌洗。OBJECTIVE To explore the distribution of pathogens causing postoperative intracranial infections in the neurosurgery department patients undergoing craniotomy and put forward the treatment measures so as to provide guidance for prevention and treatment of the intracranial infections .METHODS The clinical data of 1 500 patients who underwent the craniotomy in the department of neurosurgery from Jan 2008 to Jun 2015 were retrospectively analyzed ,and the incidence of intracranial infections and characteristics of pathogens were observed .The patients with intracranial infections were treated with intraventricular irrigation or intrathecal irrigation of antibiotics ,and the curative effect was compared between the two drug delivery methods .RESULTS Of 1 500 patients undergoing the craniotomy ,50 had postoperative intracranial infections with the infection rate of 3 .3% .A total of 73 strains of pathogens were isolated from the cerebrospinal fluid specimens of the patients with the infections ,including 45 （61 .6% ） strains of gram‐positive bacteria ,25 （34 .3% ） strains of gram‐negative bacteria ,and 3 （4 .1% ） strains of fungi .The drug resistance rate of the Staphylococcus aureus to erythromycin was 100 .0% ,the drug resistance rate to penicillin was 90 .5% ,and the drug resistance rates to linezolid ,piperacillin‐tazobactam ,and vancomycin were 0 .The drug resistance rates of the K lebsiella pneumoniae to aztreonam was 100 .0% ,the drug resistance rate to imipenem was 0 .The total effective rate of treatment of the intraventricular irrigation group was 96 .3% , significantly higher than 73 .9% of the intrathecal irrigation group （χ2 = 5 .168 ,P〈 0 .05） .CONCLUSION The gram‐positive bacteria rank the first place of the pathogens isolated from the cerebrospinal fluid specimens of the pa‐tients with intracranial infections .The curative effect of the intraventricular irrigation is significantly better than that of the intrathecal irrigation on treatment of the patients with intracranial

关 键 词：神经外科 颅内感染 脑脊液 病原菌 治疗措施 

分 类 号：R378[医药卫生—病原生物学]