凝固酶阴性葡萄球菌相关神经外科术后脑膜炎风险因素的临床研究  

A Clinical Study on Risk Factors for Postoperative Meningitis Associated with Coagulase Negative Staphylococcus Aureus in Neurosurgery

作　　者：刘淑静[1,2] 郑光辉 李方强[1,3] 刘紫薇 谷愉愉[1,3] LIU Shujing;ZHENG Guanghui;LI Fangqiang;LIU Ziwei;GU Yuyu(Department of Clinical Diagnosis Laboratory of Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Engineering Research Center of Immunological Reagents Clinical Research,Beijing 100070,China;NMPA Key Laboratory for Quality Control of In Vitro Diagnostics,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院检验科,北京100070 [2]国家药监局体外诊断试剂质量控制重点实验室,北京100070 [3]北京市免疫试剂临床工程技术研究中心,北京100070

出　　处：《标记免疫分析与临床》2024年第6期1091-1096,1109,共7页Labeled Immunoassays and Clinical Medicine

基　　金：北京市医院管理局培育计划(批准号:PX2022021);传染病高通量测序技术医学人才计划(批准号:MTP2022A011)。

摘　　要：目的研究与凝固酶阴性葡萄球菌(CoNS)相关的神经外科术后脑膜炎的风险因素,并探讨CoNS的流行病学特征和治疗方法。方法对2020年6月至2022年6月期间神经外科手术后脑膜炎患者进行回顾性研究,并采用多因素回归方法分析CoNS相关神经外科手术后脑膜炎的风险因素。结果共收集279例脑脊液培养CoNS阳性的神经外科术后脑膜炎患者,占神经外科手术后所有细菌感染患者的9.5%(279/2950)。其中146例患者被诊断为脑膜炎,133例患者被确诊为污染。CoNS相关神经外科手术后脑膜炎患者中最常见的分别是表皮葡萄球菌(51.37%,75/146)、人葡萄球菌(20.55%,30/146)和溶血葡萄球菌(17.81%,26/146)。药敏试验表明,CoNS对青霉素G、红霉素和苯唑西林的耐药性分别为85.7%、79.6%和74.8%,对万古霉素、替加环素和利奈唑胺的敏感性为100%。单因素分析显示,开颅手术、恶性肿瘤、手术时长、脑室外引流和手术切口类型在CoNS相关术后脑膜炎组与污染组存在显著性差异;多因素分析显示,恶性肿瘤(95%置信区间1.551~5.314,P=0.001)和脑室外引流(95%置信区间1.582~5.030,P<0.001)是CoNS相关神经外科术后脑膜炎的独立危险因素。结论CoNS相关神经外科术后脑膜炎与开颅手术、手术时长、手术伤口类型等多种因素密切相关,其中患者患有恶性肿瘤和脑室外引流是它的独立危险因素。Objective To study the risk factors for postoperative meningitis associated with coagulase negative Staphylococcus aureus(CoNS)in neurosurgery,and to explore the epidemiological characteristics and treatment methods of CoNS.Methods A retrospective study was conducted for patients with post-operative meningitis in neurosurgery from June,2020 to June,2022,and a multivariate regression method was used to identify the risk factors of CoNS related post-operative meningitis in neurosurgery.Results A total of 279 neurosurgical patients with positive CoNS in cerebrospinal fluid culture were collected,accounting for 9.5%(279/2950)of all bacterial infections after neurosurgical surgery.Among them,146 patients were diagnosed with meningitis,and 133 patients were diagnosed with contamination.The most common types of meningitis in patients with CoNS related neurosurgery were Staphylococcus epidermidis(51.37%,75/146),Staphylococcus aureus(20.55%,30/146),and Staphylococcus hemolysis(17.81%,26/146).The drug sensitivity test showed that the resistance of CoNS to penicillin G,erythromycin,and oxacillin were 85.7%,79.6%,and 74.8%,respectively,while the sensitivity to vancomycin,tigecycline,and linezolid was 100%.Univariate analysis showed significant differences between the CoNS related postoperative meningitis group and the contaminated group in terms of craniotomy surgery,malignant tumors,surgical duration,ventricular drainage,and surgical incision type;Multivariate analysis showed that malignant tumors(95%confidence interval 1.551-5.314,P=0.001)and extraventricular drainage(95%confidence interval 1.582-5.030,P<0.001;)were independent risk factors for postoperative meningitis related to CoNS neurosurgery.Conclusion Postoperative meningitis related to CoNS neurosurgery is closely related to various factors,including craniotomy,surgical duration,and surgical wound type.Among them,patients with malignant tumors and extraventricular drainage are independent risk factors.

关 键 词：凝固酶阴性葡萄球菌 神经外科手术后脑膜炎 污染 表皮葡萄球菌 脑室外引流 

分 类 号：R378[医药卫生—病原生物学]