神经外科术后颅内感染的病原菌分布及相关因素研究  

A study on the distribution of pathogens and related factors of intracranial infection after neurosurgery

作　　者：曹英肖 侯乾 张涛 CAO Yingxiao;HOU Qain;ZHANG Tao(Xingtai People's Hospital affiliated to Hebei Medical University,XingTai 054000,HeBei,China)

机构地区：[1]河北医科大学附属邢台市人民医院,河北邢台054000

出　　处：《中国病原生物学杂志》2024年第9期1070-1074,共5页Journal of Pathogen Biology

基　　金：河北省邢台市科技项目(No.2023ZC044)。

摘　　要：目的探析神经外科术后合并颅内感染患者的病原菌分布特点及相关影响因素。方法选取2019-2023年本院收治的148例神经外科术后合并颅内感染的患者为研究对象,同时选取100例同期术后未发生颅内感染的患者为对照组。采集颅内感染患者脑脊液标本,培养分离后进行菌种鉴定,对比不同年份革兰阳性菌、革兰阴性菌占比情况。测定两组患者血清炎症因子水平,分析血清炎症因子水平在神经外科术后合并颅内感染的单独诊断及联合诊断价值。对比两组患者临床资料,采用单因素分析和二元logistic回归分析检验神经外科术后合并颅内感染的危险因素。结果共检出病原菌164株,革兰阳性菌96株(58.54%),革兰阴性菌68株(41.46%),病原菌主要为凝固酶阴性葡萄球菌57株(34.76%)、金黄色葡萄球菌28株(17.07%)、铜绿假单胞菌32株(19.51%)。2019年检出病原菌31株,革兰阳性菌占64.52%,革兰阴性菌占35.48%;2020年病原菌27株,革兰阳性菌占62.96%,革兰阴性菌占37.04%;2021年病原菌30株,革兰阳性菌占53.33%,革兰阴性菌占46.67%;2022年病原菌34株,革兰阳性菌占61.76%,革兰阴性菌占38.24%;2023年病原菌42株,革兰阳性菌占52.38%,革兰阴性菌占47.62%。术后7 d,颅内感染组患者血清WBC为(13.18±1.81)×10^(9),PCT为(1.89±0.35)μg/L,CRP为(30.36±5.68)mg/L,对照组患者血清WBC为(9.55±1.90)×10^(9),PCT为(0.83±0.31)μg/L,CRP为(12.63±4.73)mg/L,两组患者差异有统计学意义(P<0.05)。术后7 d WBC、PCT、CRP及联合指标曲线下面积分别为0.921、0.956、0.981及0.999。对比颅内感染组与对照组患者临床资料发现,具有合并糖尿病、急诊手术、手术时间长、脑室引流时间长的神经外科患者,术后更易并发颅内感染的独立危险因素(P<0.05)。结论神经外科术后合并颅内感染患者,病原菌主要为凝固酶阴性葡萄球菌。神经外科患者手术后7 d的血清WBC、PCT、CRP水平对于术后颅Objective To explore the distribution characteristics of pathogenic bacteria and related influencing factors in patients with intracranial infection after neurosurgery.Methods 148 patients with postoperative intracranial infections in neurosurgery admitted to our hospital from 2019 to 2023 were selected as the study subjects,while 100 patients who did not experience intracranial infections after neurosurgery during the same period were selected as the control group.The cerebrospinal fluid samples were collected from patients with intracranial infections,to culture and isolate,then the bacterial species were identified.The proportion of Gram positive and Gram negative bacteria were compared in different years.The levels of serum inflammatory factors were measured in two groups of patients,and the diagnostic value of serum inflammatory factor levels in the individual and combined diagnosis of postoperative intracranial infections in neurosurgery were analyzed.The clinical data of two groups of patients were compared and the the risk factors of postoperative intracranial infection in neurosurgery were tested by univariate analysis and binary logistic regression analysis.Results A total of 164 strains of pathogenic bacteria were detected,including 96 strains(58.54%)of Gram-positive bacteria and 68 strains(41.46%)of Gram-negative bacteria.The main pathogenic bacteria were 57 strains(34.76%)of coagulase-negative staphylococcus,28 strains(17.07%)of Staphylococcus aureus,and 32 strains(19.51%)of Pseudomonas aeruginosa.In 2019,there were 31 pathogenic bacteria,with Gram-positive bacteria accounting for 64.52%and Gram-negative bacteria accounting for 35.48%.In 2020,there were 27 pathogenic bacteria,with Gram-positive bacteria accounting for 62.96%and Gram-negative bacteria accounting for 37.04%.In 2021,there were 30 pathogenic bacteria,with Gram-positive bacteria accounting for 53.33%and Gram-negative bacteria accounting for 46.67%.In 2022,there were 34 pathogenic bacteria,with Gram-positive bacteria accounting for 61.76%a

关 键 词：神经外科 颅内感染 病原菌 影响因素 

分 类 号：R446.5[医药卫生—诊断学] R651[医药卫生—临床医学]