Kourbeti Irene S, Papadakis John A, Neophytou Christodoulos, Filippou Maria, Ioannou Antonis, Karabetsos Dimitris A, Bertsias George, Anastasaki Maria, Vakis Antonis F
Department of Internal Medicine, University Hospital of Heraklion, Crete, Greece.
Br J Neurosurg. 2011 Feb;25(1):9-15. doi: 10.3109/02688697.2010.500411. Epub 2010 Jul 22.
Several factors place victims with traumatic brain injury (TBI) at increased risk for infection. The purpose of this study was to delineate the frequency, types and risk factors for infection in patients with TBI who undergo neurosurgery.
Retrospective surveillance of infections in patients with TBI, aged ≥18 years who underwent neurosurgery in University of Crete between 1999 and 2005.
Two hundred fifty-eight patients (76.7% men) who underwent 342 procedures were included. One hundred forty-two infections occurred, mainly lower respiratory tract infections (44.4% of the number of infections) and surgical site infections (SSIs) (25.4%). In multivariate analysis, SSIs were independently associated with the length of stay (p < 0.001), history of malignancy (p = 0.008), CSF leak (p = 0.012), any concomitant infection (p = 0.010), particularly urinary tract infections (p = 0.001) and the use of lumbar and/or ventricular drains (p = 0.005). Meningitis was independently associated with the total length of stay (p < 0.001), the need for intubation and mechanical ventilation beyond surgery (p = 0.028) and the presence of a lumbar and/or ventricular drain (p < 0.001).
Respiratory tract infections were common in patients with TBI who underwent surgery with Acinetobacter spp. being the emerging offending pathogens. Device-related postoperative communication of the CSF and the environment was a significant risk factor for SSI development and meningitis in particular. Malignancy was an independent risk factor for SSIs. The prevalence of the offending pathogens must be determined institution by institution for the establishment of proper antibiotic treatment on suspicion.
多种因素使创伤性脑损伤（TBI）患者感染风险增加。本研究旨在明确接受神经外科手术的TBI患者感染的频率、类型及危险因素。
对1999年至2005年间在克里特大学接受神经外科手术、年龄≥18岁的TBI患者的感染情况进行回顾性监测。
纳入258例接受342次手术的患者（76.7%为男性）。发生142例感染，主要为下呼吸道感染（占感染例数的44.4%）和手术部位感染（SSIs，占25.4%）。多因素分析显示，SSIs与住院时间（p<0.001）、恶性肿瘤病史（p=0.008）、脑脊液漏（p=0.012）、任何合并感染（p=0.010），尤其是尿路感染（p=0.001）以及使用腰大池和/或脑室引流管（p=0.005）独立相关。脑膜炎与总住院时间（p<0.001）、术后需要插管和机械通气（p=0.028）以及存在腰大池和/或脑室引流管（p<0.001）独立相关。
接受手术的TBI患者中呼吸道感染常见，不动杆菌属为新出现的致病病原体。与器械相关的脑脊液与外界术后相通是SSIs尤其是脑膜炎发生的重要危险因素。恶性肿瘤是SSIs的独立危险因素。必须逐个机构确定致病病原体的流行情况，以便在怀疑感染时制定适当的抗生素治疗方案。
