颅脑术后患者并发颅内感染病原学特点及脑脊液炎性因子预测价值分析  

Analysis of the etiological characteristics of postoperative intracranial infection in patients after craniocerebral surgery and the predictive value of cerebrospinal fluid inflammatory factors

作　　者：辛玉玲 翟娟 郭璐 齐燕辉 李春辉 XIN Yuling;ZHAI Juan;GUO Lu;QI Yanhui;LI Chunhui(Xingtai People's Hos pital Affiliated to Hebei Medical University,XingTai 054000,HeBei,China;The first hospital of Hunan university of Chinese Medicine)

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 [2]湖南中医药大学第一附属医院

出　　处：《中国病原生物学杂志》2025年第4期508-511,516,共5页Journal of Pathogen Biology

基　　金：河北省邢台市科技项目(No.2023ZC044);湖南省临床医疗技术创新引导项目(No.2021SK51404);湖南省卫生健康委卫生适宜技术推广项目(No.202319019034)。

摘　　要：目的分析颅脑术后患者并发颅内感染的病原学特点,探讨脑脊液中炎性因子的变化及其对感染的预测价值,为临床早期诊断和干预提供理论依据。方法选取85例于本院接受治疗的颅脑手术并发颅内感染患者为本次研究对象,收集其脑脊液样本进行病原菌培养和鉴定,同时检测炎性因子水平,采用统计学方法分析病原菌种类及其对抗生素的敏感性,以及炎性因子对颅内感染的预测价值。结果85例颅内感染患者中,共分离出85株病原菌。其中,革兰阳性菌占55.29%,共47株;革兰阴性菌占30.59%,共26株;真菌占14.12%,共12株。革兰阳性菌中,人葡萄球菌15株,金黄色葡萄球菌12株,表皮葡萄球菌7株,肺炎链球菌5株,头状葡萄球菌3株,口腔链球菌3株,缓症链球菌2株。革兰阴性菌中,肺炎克雷伯菌7株,鲍曼不动杆菌5株,铜绿假单胞菌5株,大肠埃希菌3株,阴沟肠杆菌2株,黏质沙雷菌2株,嗜麦芽寡养单胞菌1株,奇异变形杆菌1株。真菌中,白色假丝酵母菌9株,隐球菌3株。革兰阳性菌对青霉素、克林霉素、氯霉素、阿莫西林、左氧氟沙星的耐药率较高,未产生对万古霉素、利奈唑胺的耐药株。革兰阴性菌对庆大霉素、左氧氟沙星、环丙沙星、复方新诺明的耐药率较高,对亚胺培南、美罗培南、阿米卡星的耐药率较低。感染组患者脑脊液PCT、CRP、TNF-α、WBC水平分别为(5.59±2.30)ng/L、(14.51±4.40)mg/L、(5.47±2.23)ng/L、(12.91±3.77)×10^(9)/L,显著高于对照组的(0.72±0.42)ng/L、(3.79±2.17)mg/L、(1.34±0.55)ng/L、(9.30±3.34)×10^(9)/L,对比差异具有统计学意义(P<0.05)。ROC分析显示,脑脊液PCT、CRP、TNF-α、WBC水平预测颅脑术后并发颅内感染的曲线下面积(AUC)分别为0.998(95%CI:0.996~1)、0.989(95%CI:0.977~1)、0.998(95%CI:0.994~1)、0.765(95%CI:0.692~0.838)。结论颅脑术后并发颅内感染患者,病原菌主要为革兰阳性菌,以人葡萄球菌为主,对临床常用的Objective The etiological characteristics of postoperative intracranial infection in patients after craniocerebral surgery were analyzed and the changes of inflammatory factors in cerebrospinal fluid and their predictive value for infection were explored,for providing a theoretical basis for early clinical diagnosis and intervention.Methods 85 patients with intracranial infection after craniocerebral surgery who were treated in our hospital were selected as the research objects for this study.Cerebrospinal fluid samples were collected for pathogen culture and identification.At the same time,the levels of inflammatory factors were detected.Statistical methods were used to analyze the types of pathogens and their sensitivity to antibiotics,as well as the predictive value of inflammatory factors for intracranial infection.Results Among the 85 patients with intracranial infection,a total of 85 pathogenic bacteria were isolated.Among them,Gram-positive bacteria accounted for 55.29%,with a total of 47 strains;Gram-negative bacteria accounted for 30.59%,with a total of 26 strains;fungi accounted for 14.12%,with a total of 12 strains.Among Gram-positive bacteria,there were 15 strains of Staphylococcus hominis,12 strains of S.aureus,7 strains of S.epidermidis,5 strains of Streptococcus pneumoniae,3 strains of S.capitis,3 strains of Streptococcus oralis,and 2 strains of S.mitis.Among Gram-negative bacteria,there were 7 strains of Klebsiella pneumoniae,5 strains of Acinetobacter baumannii,5 strains of Pseudomonas aeruginosa,3 strains of Escherichia coli,2 strains of Enterobacter cloacae,2 strains of Serratia marcescens,1 strain of Stenotrophomonas maltophilia,and 1 strain of Proteus mirabilis.Among fungi,there were 9 strains of Candida albicans and 3 strains of Cryptococcus.Gram-positive bacteria had a high resistance rate to penicillin,clindamycin,chloramphenicol,amoxicillin,and levofloxacin.No drug-resistant strains to vancomycin and linezolid were produced.Gram-negative bacteria had a high resistance rate to gentamicin,l

关 键 词：颅内感染 病原菌 脑脊液 炎性因子 

分 类 号：R651.1[医药卫生—外科学]