Research of the characteristic of pathogenic bacteria and risk factors in intracranial infection after hypertensive cerebral hemorrhage
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摘要:
目的 分析高血压脑出血术后颅内感染的病原菌特征及其相关危险因素，为临床颅内感染防治提供依据。 方法 选择2017年1月—2019年12月在滁州市第一人民医院神经外科行手术治疗的102例高血压脑出血患者为研究对象，回顾性分析其临床资料，观察颅内感染患者的病原菌分布特点，分析颅内感染相关的危险因素。 结果 102例高血压脑出血患者术后发生颅内感染23例，革兰阳性病原菌主要为表皮葡萄球菌，占25.00%，革兰阴性病原菌主要为鲍曼不动杆菌，占32.14%。其中表皮葡萄球菌对青霉素、环丙沙星、红霉素、克林霉素、利奈唑胺、万古霉素和替加环素的耐药率分别为100.00%、85.71%、100.00%、85.71%、0.00%、0.00%、0.00%，鲍曼不动杆菌对哌拉西林、头孢他啶、头孢曲松、亚胺培南、左氧氟沙星、复方新诺明和替加环素的耐药率分别为100.00%、88.89%、100.00%、44.44%、55.56%、66.67%、0.00%。感染组与非感染组患者在性别、年龄、BMI、手术时间、ASA评分和是否合并糖尿病之间差异无统计学意义(均P>0.05)，而术前格拉斯哥昏迷指数(Glasgow coma scale, GCS)评分、引流管时间和是否留置脑室引流管差异具有统计学意义(均P < 0.05)，多因素分析显示GCS评分和是否留置脑室引流管为颅内感染的独立危险因素(均P < 0.05)。 结论 高血压脑出血术后颅内感染病原菌主要为表皮葡萄球菌和鲍曼不动杆菌，且具有多重耐药的特点，术前GCS评分和是否留置脑室引流管为颅内感染的独立危险因素，临床上需引起重视。 Abstract:Objective To analyze the characteristics of pathogenic bacteria and related risk factors of intracranial infection after hypertensive cerebral hemorrhage, and provide a basis for the prevention and treatment of clinical intracranial infection. Methods A total of 102 patients with hypertensive cerebral hemorrhage who were surgically treated in the Neurosurgery Department of the First People's Hospital of Quzhou from January 2017 to December 2019 were selected as the research subjects. The clinical data were retrospectively collected and analyzed. The distribution of pathogenic bacteria in patients with intracranial infection was observed, and the risk factors related to intracranial infection were analyzed. Results There were 23 cases of intracranial infection in the 102 patients with hypertensive cerebral hemorrhage. Staphylococcus epidermidis was the main gram-positive pathogen, accounting for 25.00%. Acinetobacter baumannii was the main gram-negative pathogen, accounting for 32.14%. The resistance rates of Staphylococcus epidermidis to penicillin, ciprofloxacin, erythromycin, clindamycin, linezolid, vancomycin, and tigecycline were 100.00%, 85.71%, 100.00%, 85.71%, 0.00%, 0.00% and 0.00%, respectively. The resistance rates of Acinetobacter baumannii to piperacillin, ceftazidime, ceftriaxone, imipenem, levofloxacin, compound sinomine and tigecycline were 100.00%, 88.89%, 100.00%, 44.44%, 55.56%, 66.67% and 0.00%, respectively. There were no significant differences in gender, age, BMI, operative time, ASA score, and whether with diabetes between the infected and non-infected patients (all P>0.05), but there were statistical differences in preoperative Glasgow Coma Scale (GCS) scores and whether indwelling ventricle drainage tubes and drainage tube time (all P < 0.05). Multivariate analysis showed that preoperative GCS scores and whether indwelling ventricle drainage tubes were independent risk factors for intracranial infection (all P < 0.05). Conclusion The main pathogens of intracranial infection after hypertensive intracerebral hemorrhage are mainly Staphylococcus epidermidis and Acinetobacter baumannii, with characteristics of multiple drug resistance. The preoperative GCS score and whether indwelling ventricular drainage tube are independent risk factors for intracranial infection. It needs to be paid enough attention in clinical. -
表 1 颅内感染的病原菌分布情况
病原菌 例(%) 鲍曼不动杆菌 9(32.14) 表皮葡萄球菌 7(25.00) 金黄色葡萄球菌 3(10.71) 铜绿假单胞菌 2(7.14) 肺炎克雷伯菌 2(7.14) 大肠埃希菌 2(7.14) 肺炎链球菌 1(3.57) 阴沟肠杆菌 1(3.57) 雷氏普罗威登斯菌 1(3.57) 合计 28(100.00) 
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表 2 主要病原菌的耐药性[株(%)]
抗菌药物 表皮葡萄球菌 抗菌药物 鲍曼不动杆菌 青霉素 7(100.00) 哌拉西林 9(100.00) 环丙沙星 6(85.71) 头孢他啶 8(88.89) 红霉素 7(100.00) 头孢曲松 9(100.00) 克林霉素 6(85.71) 亚胺培南 4(44.44) 利奈唑胺 0(0.00) 左氧氟沙星 5(55.56) 万古霉素 0(0.00) 复方新诺明 6(66.67) 替加环素 0(0.00) 替加环素 0(0.00)
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表 3 高血压脑出血术后颅内感染相关指标的单因素分析
因素 分类 例数 颅内感染[例(%)] χ2值 P值 性别 男性 69 12(17.39) 3.249 0.072 女性 33 11(33.33) 年龄(岁) ≥50 78 18(23.08) 0.053 0.818 ＜50 24 5(20.83) BMI ≥20 69 15(21.74) 0.080 0.778 ＜20 33 8(24.24) 术前GCS评分(分) ≥8 59 5(8.47) 15.874 <0.001 ＜8 43 18(41.86) 是否脑室外引流 是 63 22(34.92) 14.440 <0.001 否 39 1(2.56) 引流管时间(d) ≥7 28 12(42.86) 9.114 0.003 ＜7 74 11(14.86) 手术时间(h) ≥2 60 9(15.00) 3.717 0.054 ＜2 42 13(30.95) ASA评分(分) ≥2 28 7(25.00) 0.133 0.716 ＜2 74 16(21.62) 合并糖尿病 是 14 3(21.43) 0.012 0.914 否 88 20(22.73)
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表 4 高血压脑出血术后颅内感染相关指标的多因素分析
因素 B SE Wald χ2 P值 OR值 95%CI 术前GCS评分 2.051 0.560 13.394 <0.001 7.776 2.593~23.323 是否脑室外引流 1.458 0.503 8.410 0.004 4.295 1.604~11.504
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