脑脊液培养对肠杆菌导致的神经外科术后脑膜炎患者的预后分析  

A Follow-up Study of Cerebrospinal Fluid Cultures on the Prognosis of Neurosurgical Postoperative Meningitis Caused by Enterobacteriaceae

作　　者：刘雪松 李方强[1] 张丽敏[1] 刘亚楠[1] 姜文灿 刘暄 郑光辉[1] LIU Xuesong;LI Fangqiang;ZHANG Limin;LIU Yanan;JIANG Wencan;LIU Xuan;ZHENG Guanghui(Department of Clinical Diagnosis,Laboratory of Beijing Tiantan Hospital and 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

出　　处：《标记免疫分析与临床》2024年第9期1575-1579,1588,共6页Labeled Immunoassays and Clinical Medicine

基　　金：北京市医管中心“培育计划”(编号:PX2022021)。

摘　　要：目的探究肠杆菌导致的神经外科术后脑膜炎(post-neurosurgical meningitis,PNM)患者的多次随访脑脊液培养(follow-up cerebrospinal fluid cultures,FUCC)的相关风险因素,以及FUCC对患者预后的影响。方法本中心回顾性队列研究纳入了2012年至2022年首都医科大学附属北京天坛医院收治的肠杆菌导致的PNM患者,分析了FUCC对患者感染死亡率的影响,并采用多因素回归分析方法评估患者全因死亡率的危险因素。结果研究期间共纳入494例PNM患者,分离的肠杆菌主要为肺炎克雷伯菌、大肠埃希菌,奇异变形杆菌和黏质沙雷菌等,其中44例患者感染死亡,235例患者(47.6%)接受了FUCC,FUCC与肠杆菌导致的PNM患者的28d感染死亡率(HR=0.574,95%CI 0.338~0.972,P=0.039)相关,高血压、二次手术、入住ICU和辅助呼吸为肠杆菌导致的PNM患者感染死亡的危险因素,进一步比较FUCC和非FUCC之间的28d死亡率,结果显示两组之间的感染死亡率差异存在统计学意义(P=0.012),FUCC与较低的短期生存率相关,FUCC阳性并不是死亡率的预测因子(P=0.420)。结论实施FUCC已被证明可以降低肠杆菌导致的PNM患者的感染死亡率,实施FUCC是适当的患者护理和管理的一个关键组成部分,因此建议临床医生作为一种标准实践使用。Objective This study aimed to explore risk factors associated with multiple follow-up cerebrospinal fluid cultures(FUCC)in patients with post-neurosurgical meningitis(PNM)caused by Enterobacteriaceae and to further investigate the impact of FUCC on patient outcomes.Methods This single-center retrospective cohort study included patients with PNM caused by Enterobacteriaceae admitted to Beijing Tiantan Hospital,affiliated with Capital Medical University,from 2012 to 2022.The study evaluated the impact of FUCC on infection-related mortality and used multivariable regression analysis to identify risk factors for all-cause mortality.Results During the study period,a total of 494 patients with PNM were enrolled.The main types of Enterobacteriaceae isolated were Klebsiella pneumoniae,Escherichia coli,Proteus mirabilis,and Serratia marcescens.Among them,44 patients died from infections.FUCC was performed in 235 patients(59.7%),and it was associated with a reduced 28-day infection-related mortality in patients with PNM caused by Enterobacteriaceae(HR=0.574,95%CI 0.338-0.972,P=0.039).Hypertension,repeat surgery,ICU admission,and assisted ventilation were identified as risk factors for infection-related mortality in patients with PNM caused by Enterobacteriaceae.Further comparisons of the 28-day mortality between the FUCC and non-FUCC groups showed a significant difference in infection-related mortality(P=0.012),with FUCC being associated with a lower short-term survival rate.A positive FUCC was not identified as a predictor of mortality(P=0.420).Conclusion The implementation of FUCC is proven to reduce infection-related mortality in patients with PNM caused by Enterobacteriaceae.The practice of FUCC can serve as an essential component of appropriate patient care and management strategies,and it is recommended that clinicians use it as a standard practice.

关 键 词：神经外科术后脑膜炎 肠杆菌 随访脑脊液培养 危险因素 

分 类 号：R515[医药卫生—内科学] R619[医药卫生—临床医学]