Yang K-Y, Chang W-N, Ho J-T, Wang H-C, Lu C-H
Dept. of Neurosurgery and Neurology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.
Infection. 2006 Oct;34(5):247-51. doi: 10.1007/s15010-006-5607-5.
Bacterial brain abscess after a neurosurgical procedure has become an important occurrence in the hospital setting. However, no information about the frequency, clinical relevance, and the outcome has been reported.
Over a period of 19 years (1986- 2004), a total of 31 patients were retrospectively identified as having brain abscesses after neurosurgical procedures and were enrolled in this study.
Those included in this study accounted for 0.17% (31/18600) of all neurosurgical procedures in the same period. There was an increased percentage of adult postneurological nosocomial brain abscess compared to all adult bacterial brain abscesses in recent years. The majority of cases were due to Gram-negative bacilli and polymicrobial infections, including both Gram-negative bacilli and Staphylococcus species. Furthermore, the appearance of multi-antibiotic resistant strains was also noted during the study period. The overall fatality rate was 16%.
Post-neurosurgical states have become important predisposing factor for bacterial brain abscess. In patients that undergo neurosurgical procedures and develop smoldering fever, progressively disturbed consciousness, headache, and new onset focal neurologic signs, immediate neuro-imaging studies should be undertaken to determine whether bacterial brain abscess is present. Although mortality may be related to the primary brain pathology, early diagnosis and timely use of appropriate antibiotics based on antimicrobial susceptibility testing are also essential for survival.
神经外科手术后发生细菌性脑脓肿已成为医院环境中的一个重要问题。然而，关于其发生率、临床相关性及预后的信息尚未见报道。
在19年期间（1986 - 2004年），共有31例患者经回顾性研究确定为神经外科手术后发生脑脓肿，并纳入本研究。
本研究纳入的患者占同期所有神经外科手术的0.17%（31/18600）。近年来，成人神经外科医院获得性脑脓肿在所有成人细菌性脑脓肿中所占比例有所增加。大多数病例由革兰氏阴性杆菌和混合菌感染引起，包括革兰氏阴性杆菌和葡萄球菌属。此外，在研究期间还注意到多重耐药菌株的出现。总体死亡率为16%。
神经外科手术后状态已成为细菌性脑脓肿的重要易感因素。对于接受神经外科手术且出现低热、意识逐渐障碍、头痛及新发局灶性神经体征的患者，应立即进行神经影像学检查以确定是否存在细菌性脑脓肿。虽然死亡率可能与原发性脑病变有关，但早期诊断并根据药敏试验及时使用合适的抗生素对于生存也至关重要。
