颅底肿瘤患者鼻内镜颅底手术术后颅内感染的病原菌分布与相关因素分析  

Pathogen distribution and risk factors of intracranial infections after endoscopic skull base surgery in patients with skull base tumor

作　　者：王琼[1] 赖永金 李斌[3] 胡福军[3] 何福根[1] 

机构地区：[1]浙江省肿瘤医院中药房,浙江杭州310008 [2]赣州市中医医院神经内科,江西赣州341000 [3]浙江省肿瘤医院头颈放疗科,浙江杭州310008

出　　处：《中华医院感染学杂志》2017年第23期5362-5365,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生基金资助项目(2015KYB369)

摘　　要：目的探讨颅底肿瘤患者鼻内镜颅底手术术后颅内感染的病原菌分布与危险因素。方法选择2012年1月-2017年1月期间医院收治的行鼻内镜颅内手术的颅底肿瘤患者943例;对发生术后颅内感染的发生率及危险因素进行观察分析;对发生术后颅内感染患者脑脊液中的病原菌分布及耐药性进行比较分析。结果 943例患者中发生术后颅内感染的患者47例,感染率4.98%;47例感染患者分离培养病原菌69株,其中革兰阳性菌41株占59.42%,革兰阴性菌28株占40.58%;金黄色葡萄球菌对青霉素G、红霉素、利福平耐药率较高,凝固酶阴性葡萄球菌对红霉素和青霉素G耐药率较高;鲍氏不动杆菌对亚胺培南、头孢他啶耐药率较高,铜绿假单胞菌对阿米卡星和美罗培南耐药率较高;多因素Logistic回归分析结果显示:颅底重建、脑脊液鼻漏、颅底手术史、术前应用抗菌药物为术后颅内感染独立危险因素(P<0.05)。结论颅底肿瘤患者鼻内镜颅底手术术后颅内感染以革兰阳性菌为主,术后颅内感染相关因素较多。应按照病原学类型采取针对性预防感染措施,且有效监测存在的感染因素,降低感染率。OBJECTIVE To investigate pathogen distribution and risk factors of intracranial infections after endoscopic skull base surgery in patients with skull base tumor.METHODS A total of 943 patients with skull base tumors who underwent endoscopic sinus surgery from Jan.2012 to Jan.2017 were selected.The incidence and risk factors of postoperative intracranial infections were observed and analyzed.The distribution and drug resistance of pathogenic bacteria in cerebrospinal fluid of patients with postoperative intracranial infection were analyzed and compared.RESULTS There were 47 patients had postoperative intracranial infection among 943 cases,with the infection rate of 4.98%.Totally 69 strains of pathogens were isolated and cultured,among which 41 strains were gram-positive bacteria,accounting for 59.42%,and 28 strains were gram-negative bacteria,accounting for40.58%.The resistant rates of Staphylococcus aureus to penicillin G,erythromycin and rifampicin were high;Coagulase-negative Staphylococci had high resistant rate to erythromycin and penicillin G.Acinetobacter baumannii had high resistant rates to imipenem and ceftazidime.Pseudomonas aeruginosa had high resistant rate to amikacin and meropenem.The results of multivariate logistic regression analysis showed that,skull base reconstruction,cerebrospinal fluid rhinorrhea,skull base surgery,and preoperative use of antibacterial drugs were the independent risk factors of postoperative intracranial infections（P〈 0.05）.CONCLUSIONIntracranial infections art mainly caused by gram-positive bacteria in patients with skull base tumor after endoscopic skull base surgery,and there are many factors associated with intracranial infections after operation.Targeted infection prevention measures should be taken according to the etiology types,and effective monitoring of the existing infection factors should be taken as much as possible to reduce the infection rate.

关 键 词：颅底肿瘤 鼻内镜颅底手术 病原菌 术后颅内感染 危险因素 

分 类 号：R619.3[医药卫生—外科学]