脑胶质瘤手术患者术后颅内感染病原学特点及危险因素分析  

Characteristics and risk factors of intracranial infections after operation in patients with brain glioma

作　　者：沈罡 朱光耀 孙成丰 王波定 李甲 SHEN Gang ZHU Guang-yao SUN Cheng-feng WANG Bo-ding LI Jia(Eastern Hospital of Li Huili, The Medical Center of Ningbo, Zhejiang 315040, China)

机构地区：[1]宁波市医疗中心李惠利东部医院神经外科,浙江宁波315040

出　　处：《中华医院感染学杂志》2017年第20期4697-4699,4715,共4页Chinese Journal of Nosocomiology

基　　金：宁波市自然基金资助项目(2012A610195)

摘　　要：目的探讨脑胶质瘤手术后颅内感染病原菌特点及危险因素。方法选取医院2008年1月-2016年12月收治的脑胶质瘤手术患者94例,回顾性分析颅内感染患者脑脊液培养病原菌分布和其对抗菌药物的耐药性及发生感染的危险因素。结果 94例脑胶质瘤手术患者术后颅内感染患者13例,感染率为13.83%;共分离培养病原菌36株,其中革兰阳性菌22例占61.11%,革兰阴性菌14例占38.89%;革兰阳性菌中金黄色葡萄球菌对红霉素、青霉素、四环素耐药率较高,分别为100.00%、90.00%、70.00%;表皮葡萄球菌对青霉素、四环素、红霉素耐药率较高,分别为100.00%、87.50%、75.00%;革兰阴性菌中肺炎克雷伯菌对头孢呋辛、氨苄西林耐药率较高,均为83.33%;鲍氏不动杆菌对氨苄西林、头孢呋辛耐药率较高,分别为100.00%、80.00%。年龄、手术时间、预防性抗菌药物为术后颅内感染的独立危险因素(P<0.05)。结论脑胶质瘤手术患者术后颅内感染病原菌以革兰阳性菌居多,应根据药敏结果合理使用抗菌药物,并注意感染危险因素以降低感染率。OBJECTIVE To investigate the characteristics and risk factors of intracranial infections after operation in patients with brain glioma.METHODS A total of 94 patients with brain glioma in hospital from Jan.2008 to Dec.2016 were selected.The distribution of pathogens in cerebrospinal fluid,antimicrobial resistance and risk factors of infection in patients with intracranial infections were analyzed.RESULTS Totally 13 cases of intracranial infections were found in 94 patients with brain glioma,and the infection rate was 13.83%.Totally 36 strains of pathogenic bacteria were isolated and cultured,among which 22 cases were gram-positive bacteria,accounting for 61.11%,and 14 cases were gram-negative bacteria,accounting for 38.89%.Gram positive bacteria Staphylococcus aureus had high resistant rate to erythromycin,penicillin and tetracycline,which were 100.00%,90.00% and70.00%,respectively;and Staphylococcus epidermidis had high resistant rate to penicillin,tetracycline and erythromycin,which were 100.00%,87.50% and 75.00% respectively.Gram-negative bacteria Klebsiella pneumoniae had high resistant rate to cefuroxime and ampicillin,which were both 83.33%;and Acinetobacter baumannii had high resistant rate to ampicillin and cefuroxime,which were respectively 100% and 80%.Age,duration of surgery and prophylactic antibiotics were independent risk factors for postoperative intracranial infections（P〈0.05）.CONCLUSION The pathogens of postoperative intracranial infections in patients with brain glioma were mainly gram-positive bacteria.Rational use of antibiotics should be taken according to drug sensitivity,and risk factors for infection should be paid attention in order to reduce the infection rate.

关 键 词：脑胶质瘤手术 颅内感染 病原菌 危险因素 

分 类 号：R619.3[医药卫生—外科学]