多重耐药非发酵革兰阴性菌导致的神经外科术后脑膜炎患者的流行病学与风险因素研究  

Epidemiology and risk factors of patients with post-neurosurgical meningitis caused by multi-drug resistance non-fermenta-tive gram negative bacteria

作　　者：刘志伟[1] 孙嘉潞 王思琪 李响[1] 郑光辉[1] 单凯[2] LIU Zhi-wei;SUN Jia-lu;WANG Si-qi(Department of Clinical Laboratory 2.Department of Emergency,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院实验诊断中心,北京100070 [2]首都医科大学附属北京天坛医院急诊科,北京100070

出　　处：《中国实验诊断学》2023年第4期430-435,共6页Chinese Journal of Laboratory Diagnosis

基　　金：北京市医管中心“扬帆计划”(ZYLX202108);北京市医管中心“培育计划”(PX2022021)。

摘　　要：目的探究神经外科术后脑膜炎(PNM)患者感染多重耐药(MDR)非发酵革兰氏阴性杆菌(NFGNB)的流行病学特征并评估其相关的风险因素。方法回顾性分析2013~2020年间,首都医科大学附属北京天坛医院神经外科术后感染NFGNB患者,分析其流行病学特征。通过Mann-Whitney U检验遴选潜在的MDR-NFGNB的感染风险因素,并通过构建多因素回归分析评价患者的独立风险因素。结果本研究共纳入患者2940人,207例患者感染NFGNB。NFGNB感染相关PNM患者中,MDR-NFGNB组84人,非MDR-NFGNB组123人。分离率前三的NFGNB分别为鲍曼不动杆菌(105例,50.7%),铜绿假单胞菌(29例,14.0%)与洛菲不动杆菌(20例,9.7%)。NFGNB导致的PNM患者中,患者存在脑外伤(OR 14.244,95%CI 1.627~124.702,P=0.016)与辅助呼吸(OR 3.898,95%CI 1.919~7.917,P<0.001)为MDR-NFGNB感染患者的独立感染风险因素。结论MDR-NFGNB导致的PNM严重影响神经外科手术患者临床预后,脑外伤及合并辅助呼吸是此类患者的独立风险因素,临床上应早期防治,降低感染率。Objective To explore the epidemiology of post-neurosurgical infection(PNM)patients caused by multidrug resistance non-fermentative bacteria and evaluate the related risk factors.Methods A retrospective analysis of patients infected with non-fermenting bacteria after neurosurgery in Beijing Tiantan Hospital&Capital Medical University from 2013 to 2020,Risk factors for potential MDR-NFGNB were selected by Mann-Whitney U test,and independent risk factors for patients were evaluated by constructing multivariate regression analysis.Results A total of 2940 patients were enrolled in this study,and 207 patients were infected with NFGNB.84 patients in the MDR-NFGNB group and 123 patients in the non MDR-NRGNB group.The top three NFGNBs were Acinetobacter baumannii(105 cases,50.7%),Pseudomonas aeruginosa(29 cases,14.0%)and Acinetobacter lofti(20 cases,9.7%).Among patients with PNM due to NFGNB,traumatic brain injury(OR 14.244,95%CI 1.627~124.702,P=0.016),and assisted ventilation(OR 3.898,95%CI 1.919~7.917,P<0.001)as independent risk factors for MDR-NFGNB PNM patients.Conclusion Patients with PNM due to MDR-NFGNB are a serious clinical hazard,and patients with traumatic brain injury and combined assisted ventilation are independent risk factors for this patient and should be prevented and treated early to reduce the infection rate in clinical practice.

关 键 词：神经外科术后脑膜炎 多重耐药 风险因素 非发酵革兰氏阴性杆菌 

分 类 号：R446.5[医药卫生—诊断学] R512.3[医药卫生—临床医学]