發(fā)布時間：2018-06-03 08:43

  本文選題：神經(jīng)外科 + 術后顱腦感染��； 參考：《中國病原生物學雜志》2017年06期

【摘要】：目的分析神經(jīng)外科患者術后顱腦感染的病原學特點,并對病原菌的臨床耐藥情況及感染相關因素進行分析,為神經(jīng)外科患者術后顱腦感染的防控提供科學指導。方法收集神經(jīng)外科術后顱腦感染患者臨床資料,從送檢腦脊液標本中分離病原菌,采用全自動微生物鑒定儀進行菌株鑒定,采用K-B法分析病原菌的耐藥性。結果 266例神經(jīng)外科患者中,術后顱內(nèi)感染80例,感染率30.08%。從80例感染患者腦脊液標本中共分離84株病原菌,其中革蘭陽性菌53株,革蘭陰性菌29株,真菌2株。革蘭陽性菌中,凝固酶陰性葡萄球菌27株,金黃色葡萄球菌12株,糞腸球菌12株,其他4株;革蘭陰性菌中,鮑曼不動桿菌16株,肺炎克雷伯菌6株,大腸埃希菌3株,銅綠假單胞菌2株,其他2株。凝固酶陰性葡萄球菌和金黃色葡萄球菌對環(huán)丙沙星、頭孢他啶、頭孢曲松、氯霉素和萬古霉素的耐藥率分別為33.33%、44.44%、40.74%、55.56%、0和33.33%、66.67%、58.33%、66.67%、0;糞腸球菌對環(huán)丙沙星、頭孢他啶、頭孢曲松、氯霉素、莫西沙星、加替沙星的耐藥率分別為30.00%、50.00%、40.00%、60.00%、10.00%和10.00%。鮑曼不動桿菌和肺炎克雷伯菌對環(huán)丙沙星、頭孢他啶、美羅培南、頭孢曲松、氯霉素的耐藥率分別為37.50%、50.00%、18.75%、43.75%、50.00%和33.33%、50.00%、0、50.00%、33.33%。年齡60歲患者顱腦感染率為17.80%,≥60歲者為39.86%;有腦室外引流者感染率為47.78%,無腦室外引流者為21.20%;有腦脊液外漏者感染率為45.63%,無腦脊液外漏者為20.25%;術前使用抗生素者感染率為53.27%,術前未使用抗生素者為14.47%;感染率差異均有統(tǒng)計學意義(χ2=15.2040,20.2696,19.3411,45.7982,P均0.05)。結論在神經(jīng)外科患者術后顱腦感染的病原學特點分析中,病原菌類型以革蘭陽性菌居多,其中又以凝固酶陰性葡萄球菌分離率最高,臨床應高度重視此類病原菌的傳播擴散。鑒于臨床分離株的耐藥程度,臨床應合理選用抗菌藥物,高效防治神經(jīng)外科患者術后顱腦感染發(fā)生。神經(jīng)外科患者年齡、腦室外引流、腦脊液外漏以及術前使用抗生素情況是發(fā)生顱腦感染的相關因素,臨床應給予這些因素重視,并且對病原菌耐藥性分析對治療患者意義重大。
[Abstract]:Objective to analyze the etiology of postoperative craniocerebral infection in Department of Neurosurgery, and to analyze the clinical resistance and related factors of pathogenic bacteria, and to provide scientific guidance for the prevention and control of craniocerebral infection after operation in Department of neurosurgery. Methods the clinical data of the patients with craniocerebral infection after the operation were collected and the samples were separated from the specimens of the cerebrospinal fluid. The pathogenic bacteria were identified by the automatic microbial identification instrument and the K-B method was used to analyze the drug resistance of the pathogenic bacteria. Results in 266 Department of neurosurgery patients, 80 cases were infected with intracranial infection, and the infection rate of 30.08%. was isolated from 80 cases of the cerebrospinal fluid samples from the infected patients. Among them, 53 strains of Gram-positive bacteria, 29 Gram-negative bacteria and 2 fungi. Among Gram-positive bacteria, 27 strains of coagulase negative staphylococcus, 12 strains of Staphylococcus aureus, 12 strains of Enterococcus faecalis, 4 other strains, 16 strains of Acinetobacter Bauman, 6 Klebsiella pneumoniae, 3 Escherichia coli, 2 Pseudomonas aeruginosa, 2 strains, coagulase negative Staphylococcus and Staphylococcus aureus to ciprofloxacin, the head of ciprofloxacin, and the head of ciprofloxacin. The resistance rates of sporotazidime, ceftriaxone, chloramphenicol, and vancomycin were 33.33%, 44.44%, 40.74%, 55.56%, 0 and 33.33%, 66.67%, 58.33%, 66.67%, 0; the resistance rates of Enterococcus faecalis to ciprofloxacin, ceftazidime, ceftriaxone, chloramphenicol, moxifloxacin, and gatifloxacin were respectively 30%, 50%, 40%, 60%, and 10.00%. Bauman. The resistance rates of bacteria and Klebsiella pneumoniae to ciprofloxacin, ceftazidime, meropenem, ceftriaxone, chloramphenicol were 37.50%, 50%, 18.75%, 43.75%, 50% and 33.33%, 50%, 0,50.00%, and 60 years old were 17.80%, and 60 years old were 39.86%, and the infection rate of external ventricular drainage was 47.78% and no external ventricular drainage. The infection rate was 21.20%, the infection rate of the cerebrospinal fluid leakage was 45.63%, the non cerebrospinal fluid leakage was 20.25%, the infection rate was 53.27% before operation and 14.47% before the operation, and the difference of infection rate was statistically significant (x 2=15.2040,20.2696,19.3411,45.7982, P 0.05). In the analysis of the original characteristics, the types of pathogenic bacteria are mostly Gram-positive bacteria, and the isolation rate of coagulase negative staphylococcus is the highest, and the spread of this pathogen should be paid great attention to. In view of the degree of drug resistance of the clinical isolates, the antibiotics should be rationally selected in clinical, and the head infection of the patients in the Department of neurosurgery is highly effective. Surgical patients' age, external ventricular drainage, cerebrospinal fluid leakage, and preoperative use of antibiotics are related factors for the occurrence of craniocerebral infection. These factors should be paid attention to, and the analysis of drug resistance to pathogenic bacteria is of great significance for the treatment of patients.
【作者單位】： 三峽大學第三臨床醫(yī)學院葛洲壩集團中心醫(yī)院;
【分類號】：R651

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相關期刊論文 前10條

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本文編號：1972174