后颅凹开颅术后感染病原菌与耐药性及影响因素分析  

Distribution and drug resistance of pathogens isolated from posterior fossa craniotomy patients with postoperative infection and influencing factors

作　　者：陈立珂[1] 杨呈浩[1] 蓝美锐[1] 陈岷辉[1] 丁昊[1] CHEN Li-ke;YANG Cheng-hao;LAN Mei-rui;CHEN Min-hui;DING Hao(Fourth People′s Hospital of Zigong,Zigong,Sichuan 643000,China)

机构地区：[1]自贡市第四人民医院神经外科,四川自贡643000

出　　处：《中华医院感染学杂志》2020年第2期208-211,共4页Chinese Journal of Nosocomiology

基　　金：四川省卫生和计划委员会科研基金资助项目(140110)。

摘　　要：目的探究后颅凹开颅术后感染病原菌分布、耐药性及影响因素。方法回顾性分析四川省自贡市第四人民医院2012年10月-2018年10月收治的562例后颅凹开颅手术患者的临床资料,统计术后颅内感染率及病原菌培养结果,分析术后感染发生的影响因素。结果共81例患者发生颅内感染,感染率为14.41%;脑脊液培养共分离出病原菌88株,其中革兰阴性菌52株,革兰阳性菌36株;主要革兰阴性菌鲍氏不动杆菌、肺炎克雷伯菌对阿米卡星、氨曲南、环丙沙星、头孢吡肟耐药株数较多,对妥布霉素、呋喃妥因耐药株数较少,主要革兰阳性菌表皮葡萄球菌、金黄色葡萄球菌对青霉素、红霉素、苯唑西林耐药株数较多,对利奈唑胺、万古霉素、利福平耐药株数较少;单因素分析结果,术中乳突气房开放、脑室管引流、手术时间≥4.5 h、术后脑脊液漏的患者颅内感染率较高(P<0.05);多因素分析结果,脑室管引流、术后脑脊液漏为后颅凹开颅手术后并发颅内感染的独立影响因素(P<0.05)。结论后颅凹术后颅内感染率较高,其病原菌多表现为多药耐药,临床应以预防为主;脑室管引流、术后脑脊液漏为后颅凹开颅手术后颅内感染的影响因素。OBJECTIVE To explore the distribution and drug resistance of pathogens isolated from the posterior fossa craniotomy patients with postoperative infection and analyze the influencing factors. METHODS The clinical data of 562 patients who received the posterior fossa craniotomy in the Fourth People′s Hospital of Zigong from Oct. 2012 to Oct. 2018 were retrospectively analyzed, the incidence of postoperative infection and result of culture of pathogens were statistically analyzed, and the influencing factors for the postoperative infection were analyzed. RESULTS Totally 81 patients had intracranial infection, with the incidence rate 14.41%.A total of 88 strains of pathogens were isolated from cerebrospinal fluid specimens, 52 of which were gram-negative bacteria, and 36 were gram-positive bacteria.Among the major species of gram-negative bacteria, there were many strains of Acinetobacter baumannii and Klebsiella pneumoniae that were resistant to amikacin, aztreonam, ciprofloxacin and cefepime and less strains that were resistant to tobramycin and nitrofurantoin.Among the major species of the gram-positive bacteria, there were many strains of Staphylococcus epidermidis and Staphylococcus aureus that were resistant to penicillin, erythromycin and oxacillin and less strains that were resistant to linezolid, vancomycin and rifampicin.The result of univariate analysis showed that the incidence of intracranial infection was high among the patients with intraoperative mastoid air cells opening, brain ependymal drainage, operation duration no less than 4.5 hours and postoperative leakage of cerebrospinal fluid(P<0.05). Multivariate analysis indicated that brain ependymal drainage and postoperative leakage of cerebrospinal fluid were the independent influencing factors for the postoperative intracranial infection in the posterior fossa craniotomy patients(P<0.05). CONCLUSION The incidence of postoperative intracranial infection is high in the posterior fossa craniotomy patients.The pathogens show multi-drug resistance, and

关 键 词：开颅术 颅内感染 病原菌 影响因素 

分 类 号：R619.3[医药卫生—外科学]