革兰阴性菌导致的开颅术后脑膜炎患者的流行病学与死亡风险因素研究  

Epidemiology and risk factors for mortality in patients with postcraniotomy meningitis caused by Gram-negative bacteria

作　　者：王思琪 郑光辉[1,2,3] 史一君 孙嘉潞 吕虹 张国军[1,2,3] WANG Siqi;ZHENG Guanghui;SHI Yijun;SUN Jialu;LYU Hong;ZHANG Guojun(Laboratory Diagnosis Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;NMPA Key Laboratory for Quality Control of In Vitro Diagnostic,Beijing 100070,China;Beijing Engineering Research Center of Immunological Reagents Clinical Research,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]国家药监局体外诊断试剂质量控制重点实验室,北京100070 [3]北京免疫试剂临床工程技术研究中心,北京100070

出　　处：《国际检验医学杂志》2025年第6期664-669,共6页International Journal of Laboratory Medicine

基　　金：北京市医管中心“扬帆计划”基金项目(ZYLX202108);北京市高层次公共卫生技术人才建设项目(学科带头人-01-13)。

摘　　要：目的探讨革兰阴性菌(GNB)导致的开颅术后脑膜炎(PM)患者的流行病学特征,并评估其相关的死亡风险因素。方法回顾性分析2019年5月至2021年12月首都医科大学附属北京天坛医院的202例PM患者,其中死亡组54例,生存组148例。分析两组微生物分布情况,并建立Cox比例风险回归模型评价患者的死亡风险因素。结果202例GNB导致的PM患者中,病死率为26.7%,分离率前3的病原体分别为肺炎克雷伯菌(24.8%)、鲍曼不动杆菌(21.8%)与大肠埃希菌(8.4%),生存组与死亡组的GNB分布比例大小接近,但死亡组的细菌分布更集中。Cox比例风险回归模型结果显示,GNB导致的PM患者中,高血压(HR=2.384,95%CI 1.229~4.626,P=0.010)、入住ICU(HR=3.695,95%CI 1.412~9.670,P=0.008)为患者死亡的独立风险因素。结论GNB导致的PM患者具有较高的病死率,高血压、入住ICU是患者死亡的独立风险因素,临床上应该注意防治。Objective To investigate the epidemiological characteristics of patients with postcraniotomy meningitis(PM)caused by Gram-negative bacteria(GNB),and to evaluate the related risk factors for mortality.Methods A total of 202 PM patients in Beijing Tiantan Hospital,Capital Medical University from May 2019 to December 2021 were retrospectively analyzed,including 54 cases in the death group and 148 cases in the survival group.The distribution of microorganisms in the two groups was analyzed,and Cox proportional hazards regression model was established to evaluate the risk factors of death.Results Among the 202 patients with PM caused by GNB,with a mortality rate of 26.7%,Klebsiella pneumoniae(24.8%),Acinetobacter baumannii(21.8%)and Escherichia coli(8.4%)were the top three isolated pathogens.The proportions of GNB distribution in the survival group and the death group were similar,but the bacteria distribution in the death group was more concentrate.Cox proportional hazards regression model results showed that hypertension(HR=2.384,95%CI 1.229-4.626,P=0.010)and admi ssion to ICU(HR=3.695,95%CI 1.412-9.670,P=0.008)were independent risk factors for death in patients with PM caused by GNB.Conclusion The mortality of PM caused by GNB is high.Hypertension and admission to ICU are independent risk factors for death of patients,and attention should be paid to prevention and treatment in clinical practice.

关 键 词：流行病学 开颅术后脑膜炎 风险因素 革兰阴性菌 

分 类 号：R446.5[医药卫生—诊断学]