开颅术后患者的感染情况及抗菌药物使用分析
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摘要
目的:考察神经外科开颅术后患者颅内感染的发生率及抗菌药物应用效果。方法:纳入2016年6月—2018年6月我院神经外科收治的262例开颅手术患者进行临床观察。监测患者体温和脑脊液,考察颅内感染发生率、病原菌(根据药敏试验调整抗菌药用药方案)及抗菌药的治疗效果。结果:262例患者中并发颅内感染9例,发生率为3.44%;对9例患者的腰大池引流脑脊液检测发现;革兰阳性菌8例,其中表皮葡萄球菌5例、金黄色葡萄球菌3例;检出革兰阴性菌9例,其中不动杆菌属4例、克雷伯菌属3例、铜绿假单胞菌2例;对患者均行敏感抗菌药(万古霉素50 mg)联合小量激素(地塞米松2.5 mg)腰大池灌洗治疗后,8例患者获得临床治愈,1例患者临床好转;随访3个月,1例老年患者有轻度脑萎缩,其余患者均预后良好。结论:对神经外科患者术后并发颅内感染可经脑脊液持续引流和万古霉素联合地塞米松的腰大池灌注疗法治疗,多数患者能获得临床治愈和良好预后。
Objective: To investigate the incidence of intracranial infection and the use of antimicrobials in patients undergoing neurosurgical craniotomy. Methods: 262 patients undergoing craniotomy admitted to our hospital from June 2016 to June 2018 were enrolled for clinical observation. The body temperature and cerebrospinal?uid of the patients were monitored, and the incidence of intracranial infection, pathogens(antimicrobial use plan was adjusted according to drug sensitivity tests) and the therapeutic effect of the antimicrobials were investigated.Results: Of the 262 patients, 9 had intracranial infection, and the incidence rate was 3.44%. The detection of cerebrospinal ?uid drainage from lumbar cistern of the 9 patients found that 8 cases showed Gram-positive bacteria,including 5 cases of Staphylococcus epidermidis and 3 cases of Staphylococcus aureus, and 9 cases showed Gramnegative bacteria, including 4 cases of Acinetobacter, 3 cases of Klebsiella and 2 cases of Pseudomonas aeruginosa.All patients were given lumbar cistern lavage treatment of sensitive antimicrobials(vancomycin 50 mg) combined with low-dose hormone(dexamethasone, 2.5 mg), where 8 patients were clinically cured and 1 patient improved.After follow-up for 3 months, 1 elderly patient had mild brain atrophy, and the rest patients had good prognosis.Conclusion: Postoperative intracranial infection in neurosurgical patients can be treated by cerebrospinal fluid continuous drainage and lumbar cistern perfusion of vancomycin combined with dexamethasone. Most patients can obtain clinical cure and good prognosis.
Objective: To investigate the incidence of intracranial infection and the use of antimicrobials in patients undergoing neurosurgical craniotomy. Methods: 262 patients undergoing craniotomy admitted to our hospital from June 2016 to June 2018 were enrolled for clinical observation. The body temperature and cerebrospinal?uid of the patients were monitored, and the incidence of intracranial infection, pathogens(antimicrobial use plan was adjusted according to drug sensitivity tests) and the therapeutic effect of the antimicrobials were investigated.Results: Of the 262 patients, 9 had intracranial infection, and the incidence rate was 3.44%. The detection of cerebrospinal ?uid drainage from lumbar cistern of the 9 patients found that 8 cases showed Gram-positive bacteria,including 5 cases of Staphylococcus epidermidis and 3 cases of Staphylococcus aureus, and 9 cases showed Gramnegative bacteria, including 4 cases of Acinetobacter, 3 cases of Klebsiella and 2 cases of Pseudomonas aeruginosa.All patients were given lumbar cistern lavage treatment of sensitive antimicrobials(vancomycin 50 mg) combined with low-dose hormone(dexamethasone, 2.5 mg), where 8 patients were clinically cured and 1 patient improved.After follow-up for 3 months, 1 elderly patient had mild brain atrophy, and the rest patients had good prognosis.Conclusion: Postoperative intracranial infection in neurosurgical patients can be treated by cerebrospinal fluid continuous drainage and lumbar cistern perfusion of vancomycin combined with dexamethasone. Most patients can obtain clinical cure and good prognosis.
引文
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[10]周武涛,吕海欣,王博,等.神经外科患者术后颅内感染病原菌与耐药性分析[J].中华医院感染学杂志,2016,26(6):1339-1341.
[11]程浩,徐昌林,刘从国,等.神经外科患者术后颅脑感染的病原学特点及高危因素分析[J].中国病原生物学杂志,2017,12(6):574-578.
[12]张文学,方树民.神经外科患者术后颅内感染病原菌分布及相关因素分析[J].中国病原生物学杂志,2016,11(11):1035-1038.
[13]徐廷伟,敖祥生,秦永芳,等.神经外科患者术后颅内感染危险因素分析[J].中华医院感染学杂志,2016,26(8):1758-1760.
[14]卢秀花,桑林涛.不同方式治疗颅脑术后颅内感染的临床疗效及安全性研究[J].中国全科医学,2017,20(32):3996-4002.
[15]张扬,季楠,高之宪,等.预防性应用抗生素时限对神经外科Ⅰ类切口术后颅内感染影响的随机对照研究[J].中华神经外科杂志,2017,33(10):1017-1020.
[16]Mallela AN,Abdullah KG,Brandon C,et al.Topical Vancomycin Reduces Surgical-Site Infections After Craniotomy:A Prospective,Controlled Study[J].Neurosurgery2017,83(4):761-767.
[17]欧阳一彬,莫业和,刘达远,等.道路交通事故致重型颅脑损伤后并发脑积水的原因分析[J].重庆医学,2016,45(27):3862-3864,3875.
[2]曾上飞,郑海军,杨晓清,等.神经外科患者术后颅内医院感染的调查与抗菌药物使用分析[J].中华医院感染学杂志,2016,26(9):2015-2017.
[3]杨欣刚,安海龙,仲晓军,等.腰大池持续引流联合抗菌药物治疗患者术后颅内感染的疗效分析[J].中华医院感染学杂志,2016,26(4):805-806,823.
[4]李作凌,邢亚洲,马春晓,等.长期留置脑室引流管患者颅内感染的调查[J].中华医院感染学杂志,2016,26(6):1348-1350.
[5]邢永国,孟伟英,张淑祥,等.神经外科开颅术后颅内感染诊治新进展[J].中华医院感染学杂志,2016,26(22):5268-5271.
[6]吴中华,王斌,史锡文.早期行腰池引流结合抗生素治疗脑室-腹腔分流术后感染的疗效分析[J].中华神经医学杂志,2016,15(6):614-616.
[7]朱宏伟,刘希尧,谭国伟,等.1033例神经外科择期手术感染分析[J].中华医院感染学杂志,2016,26(22):5153-5155.
[8]Alotaibi AF,Hulou MM,Vestal M,et al.The Efficacy of Antibacterial Prophylaxis against the Development of Meningitis after Craniotomy:a Meta-analysis[J].World Neurosurg,2016,16(90):597-603.
[9]赵立红,石广志,王强,等.神经外科术后重症患者的医院感染病原菌分布与耐药性研究[J].中华神经外科杂志,2016,32(6):598-603.
[10]周武涛,吕海欣,王博,等.神经外科患者术后颅内感染病原菌与耐药性分析[J].中华医院感染学杂志,2016,26(6):1339-1341.
[11]程浩,徐昌林,刘从国,等.神经外科患者术后颅脑感染的病原学特点及高危因素分析[J].中国病原生物学杂志,2017,12(6):574-578.
[12]张文学,方树民.神经外科患者术后颅内感染病原菌分布及相关因素分析[J].中国病原生物学杂志,2016,11(11):1035-1038.
[13]徐廷伟,敖祥生,秦永芳,等.神经外科患者术后颅内感染危险因素分析[J].中华医院感染学杂志,2016,26(8):1758-1760.
[14]卢秀花,桑林涛.不同方式治疗颅脑术后颅内感染的临床疗效及安全性研究[J].中国全科医学,2017,20(32):3996-4002.
[15]张扬,季楠,高之宪,等.预防性应用抗生素时限对神经外科Ⅰ类切口术后颅内感染影响的随机对照研究[J].中华神经外科杂志,2017,33(10):1017-1020.
[16]Mallela AN,Abdullah KG,Brandon C,et al.Topical Vancomycin Reduces Surgical-Site Infections After Craniotomy:A Prospective,Controlled Study[J].Neurosurgery2017,83(4):761-767.
[17]欧阳一彬,莫业和,刘达远,等.道路交通事故致重型颅脑损伤后并发脑积水的原因分析[J].重庆医学,2016,45(27):3862-3864,3875.