神经外科医院感染现状及其风险评估研究进展
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摘要
神经外科病房作为医院中的危重症患者比较多的病房之一,其医院感染率和细菌耐药率均较高,革兰阴性菌是导致医院感染的主要病原菌。神经外科患者病情严重且危险、免疫力低下、手术部位创伤严重、体内病原体较为复杂、广谱抗菌药物的频繁使用、细菌出现耐药机制等均为引起感染的主要危险因素。利用风险评估模型来预测神经外科医院感染发生的风险,并前瞻性地采取相应的防控措施,以达到降低感染发生率、促进患者康复、提高医疗资源利用效率的目的。但目前对于神经外科医院感染的风险评估仍然缺乏系统化的研究,需要进一步探索。
As one of the wards with large amounts of critical patients in hospital,neurosurgery department has high rates of nosocomial infection and drug resistance.Gram-negative bacteria are the main pathogens leading to nosocomial infection.The serious illness,low immunity,severe trauma at the surgical site,complex pathogens in vivo,frequent use of broad-spectrum antibiotic drugs,and drug resistance of bacteria are the main risk factors of infection in neurosurgery patients.The risk assessment model can be used to predict the risk of nosocomial infection in neurosurgery department,and the corresponding prevention and control measures can be prospectively taken to reduce the incidence of infection,promote the recovery of patients,and improve the utilization efficiency of medical resources.However,there is still a lack of systematic research on the risk assessment of nosocomial infection in neurosurgery department,which requires further exploration.
As one of the wards with large amounts of critical patients in hospital,neurosurgery department has high rates of nosocomial infection and drug resistance.Gram-negative bacteria are the main pathogens leading to nosocomial infection.The serious illness,low immunity,severe trauma at the surgical site,complex pathogens in vivo,frequent use of broad-spectrum antibiotic drugs,and drug resistance of bacteria are the main risk factors of infection in neurosurgery patients.The risk assessment model can be used to predict the risk of nosocomial infection in neurosurgery department,and the corresponding prevention and control measures can be prospectively taken to reduce the incidence of infection,promote the recovery of patients,and improve the utilization efficiency of medical resources.However,there is still a lack of systematic research on the risk assessment of nosocomial infection in neurosurgery department,which requires further exploration.
引文
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[3]郭科营,王余军,吴自成.对进行颅脑手术后并发颅内感染的患者使用抗生素联合腰大池引流进行治疗的效果评价[J].当代医药论丛,2018,16(23):7-9.
[4]周航,王飞,李建萍,等.神经外科手术患者医院感染特点与影响因素分析[J].中华医院感染学杂志,2018,28(19):2969-2972.
[5]Stienen MN,Moser N,Krauss P,et al.Incidence,depth,and severity of surgical site infections after neurosurgical interventions[J].Acta Neurochir(Wien),2019,161(1):17-24.
[6]荣红辉,刘运喜,曹圣山,等.神经外科颅脑手术患者医院感染危险因素分析[J].中国感染控制杂志,2014,13(8):463-466.
[7]Renz N,Ozdirik B,Finger T,et al.Infections after cranial neurosurgery:prospective cohort of 103episodes treated according to a standardized algorithm[J].World Neurosurg,2018,116:e491-e499.
[8]Conen A,Fux CA,Vajkoczy P,et al.Management of infections associated with neurosurgical implanted devices[J].Expert Rev Anti Infect Ther,2017,15(3):241-255.
[9]Chiang HY1,Kamath AS,Pottinger JM,et al.Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy clinical article[J].J Neurosurg,2014,120(2):509-521.
[10]杨怀,徐艳,张骥,等.某三甲综合医院神经外科医院感染病原菌及耐药性分析[J].中华医院感染学杂志,2014,24(10):2528-2530.
[11]Rodriguez-Lucas C,Fernandez J,Boga JA,et al.Nosocomial ventriculitis caused by a meticillin-and linezolid-resistant clone of Staphylococcus epidermidis in neurosurgical patients[J].J Hosp Infect,2018,100(4):406-410.
[12]Nadkarni A,Cardwell LA,Mahler S,et al.Most common dermatology diagnoses to the emergency department in the paediatric population[J].J Eur Acad Dermatol Venereol,2018,32(4):e144-e146.
[13]von Vogelsang AC,Forander P,Arvidsson M,et al.Effect of mobile laminar airflow units on airborne bacterial contamination during neurosurgical procedures[J].J Hosp Infect,2018,99(3):271-278.
[14]Ni W,Han Y,Zhao J,et al.Tigecycline treatment experience against multidrug-resistant Acinetobacter baumannii infections:a systematic review and meta-analysis[J].Int JAntimicrob Agents,2016,47(2):107-116.
[15]Bridges KJ,Li R,Fleseriu M,et al.Candida meningitis after transsphenoidal surgery:a single-institution case series and literature review[J].World Neurosurg,2017,108:41-49.
[16]Panackal AA,Williamson PR.Fungal infections of the central nervous system[J].Continuum(Minneap Minn),2015,21(6Neuroinfectious Disease):1662-1678.
[17]肖仲祥,陈朴,邵传锋,等.重症肺部感染患者连续性肾替代治疗时比阿培南的药效学研究[J].中华医院感染学杂志,2017,27(24):5572-5575.
[18]Hoiby N,Bjarnsholt T,Givskov M,et al.Antibiotic resistance of bacterial biofilms[J].Int J Antimicrob Agents,2010,35(4):322-332.
[19]Hu H,Johani K,Almatroudi A,et al.Bacterial biofilm infection detected in breast implant-associated anaplastic largecell lymphoma[J].Plast Reconstr Surg,2016,137(6):1659-1669.
[20]Jonokuchi AJ,Knopman J,Radwanski RE,et al.Topical vancomycin to reduce surgical-site infections in neurosurgery:study protocol for a multi-center,randomized controlled trial[J].Contemp Clin Trials,2018,64:195-200.
[21]王艳新,唐明忠,徐明.神经外科手术部位感染微生物的变迁与耐药性分析[J].福建医科大学学报,2018,52(5):350-354.
[22]王璟.神经外科患者医院感染危险因素分析与干预措施[J].当代护士(中旬刊),2013(2):131-133.
[23]杨青艳,葛虹,计彦新,等.神经外科患者中心静脉导管发生感染的危险因素分析[J].世界最新医学信息文摘,2018,18(48):49,51.
[24]Strahm C,Albrich WC,Zdravkovic V,et al.Infection rate after cranial neurosurgical procedures:aprospective singlecenter study[J].World Neurosurg,2018,111:e277-285.
[25]McKerr C,Coetzee N,Edeghere O,et al.Association between post-craniotomy Propionibacterium acnes infection and dural implants:a case-econtrol study[J].J Hosp Infect,2017,97(4):389-396.
[26]Davies BM,Jones A,Patel HC.Implementation of a care bundle and evaluation of risk factors for surgical site infection in cranial neurosurgery[J].Clin Neurol Neurosurg,2016,144:121-125.
[27]Thrane JF,Sunde NA,Bergholt B,et al.Increasing infection rate in multiple implanted pulse generator changes in movement disorder patients treated with deep brain stimulation[J].Stereotact Funct Neurosurg,2014,92(6):360-364.
[28]Zhou R,Ma Y,Liu W,et al.Long-term effect of modified incision to prevent related complications in deep brain stimulation[J].World Neurosurg,2018,117:280-283.
[29]Jitkritsadakul O,Bhidayasiri R,Kalia SK,et al.Systematic review of hardware-related complications of deep brain stimulation:do new indications pose an increased risk?[J].Brain Stimul,2017,10(5):967-976.
[30]Romito LM,Zorzi G,Marras CE,et al.Pallidal stimulation for acquired dystonia due to cerebral palsy:beyond 5years[J].Eur J Neurol,2015,22(3):e426-e432.
[31]Jonokuchi AJ,Knopman J,Radwanski RE,et al.Topical vancomycin to reduce surgical-site infections in neurosurgery:study protocol for a multi-center,randomized controlled trial[J].Contemp Clin Trials,2018,64:195-200.
[32]Chiang HY,Kamath AS,Pottinger JM,et al.Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy clinical article[J].J Neurosurg,2014,120(2):509-521.
[33]Buchanan CC,Hernandez EA,Anderson JM,et al.Analysis of 30-day readmissions among neurosurgical patients:surgical complication avoidance as key to quality improvement[J].J Neurosurg,2014,121(1):170-175.
[34]李小改,郭琳,张志红,等.神经外科患者耐甲氧西林金黄色葡萄球菌感染病原菌耐药性分析[J].中华医院感染学杂志,2015,25(7):1515-1517.
[35]孟庆明,林瑞生,杨庆哲,等.比阿培南治疗神经外科感染的多中心回顾性研究[J].中华医院感染学杂志,2018,28(21):3261-3264.
[36]Rotman LE,Davis MC,Salehani AA,et al.Discrepancy between neurosurgery morbidity and mortality conference discussions and hospital quality metric standards[J].World Neurosurg,2018,115:e105-e110.
[37]Lopez Ramos C,Brandel MG,Rennert RC,et al.Clinical risk factors and postoperative complications associated with unplanned hospital readmissions after cranial neurosurgery[J].World Neurosurg,2018,119:e294-e300.
[38]Davies BM,Jones A,Patel HC.Surgical-site infection surveillance in cranial neurosurgery[J].Br J Neurosurg,2016,30(1):35-37.
[39]Buchanan IA,Donoho DA,Patel A,et al.Predictors of surgical site infection after nonemergent craniotomy:a nationwide readmission database analysis[J].World Neurosurg,2018,120:e440-e452.
[40]Kourbeti IS,Vakis AF,Ziakas P,et al.Infections in patients undergoing craniotomy:risk factors associated with post-craniotomy meningitis[J].J Neurosurg,2015,122(5):1113-1119.
[41]Cassir N,De La Rosa S,Melot A,et al.Risk factors for surgical site infections after neurosurgery:a focus on the postoperative period[J].Am J Infect Control,2015,43(12):1288-1291.
[42]Donoho DA,Wen T,Babadjouni RM,et al.Predictors of 30-and 90-day readmission following craniotomy for malignant brain tumors:analysis of nationwide data[J].J Neurooncol,2018,136(1):87-94.
[43]Mondelo Garcia C,Gutierrez Urbon JM,Perez Sanz C,et al.Auditing and improving surgical antibiotic prophylaxis[J].Surg Infect(Larchmt),2018,19(7):679-683.
[44]蒲珂,平,李国栋,等.神经外科手术中预防性应用抗生素的研究进展[J].解放军预防医学杂志,2017,35(12):1602-1605.
[45]李六亿,徐艳.医院感染管理的风险评估[J].中国感染控制杂志,2016,15(7):441-446.
[46]欧阳育琪,向阳.风险评估在医院感染控制中的应用现状与展望[J].实用预防医学,2017,24(10):1277-1280.
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