Govindaswamy Aishwarya, Bajpai Vijeta, Singh Parul, Lohiya Ayush, Ayyanar Muruganantham, Gupta Deepak Kumar, Bindra Ashish, Singh Gyaninder Pal, Mathur Purva
Department of Microbiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Department of Community Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Asian J Neurosurg. 2019 Jul-Sep;14(3):834-838. doi: 10.4103/ajns.AJNS_268_18.
The purpose of this study was to investigate the prevalence of Postoperative central nervous system infections (PCNSIs) and antibiotic resistance profiles of causative organisms in trauma patients following neuroinvasive procedures.
This was a retrospective study conducted over a period of 4 years (2013-2017). All in-patients admitted under a neurotrauma unit meeting the inclusion criteria of PCNSIs were included in the study. Surgical site infections (SSIs) were defined according to the Centers for Disease Control and Prevention 2018 (CDC) criteria. We retrospectively examined the demographic characteristics, type of neurosurgery performed, laboratory data, causative organisms, and antimicrobial susceptibility testing results of patients who had positive cerebrospinal fluid cultures following craniotomy between January 2013 and December 2017.
Of total 2500 patients operated during the study, 961 patients were screened for PCNSIs. The estimated prevalence (95% confidence interval) of PCNSIs which is a type of organ/space SSI was 7.2% (6.3-8.3). Males were predominantly affected (85.0%). The mean age (standard deviation) of patients was 31.9 (16.5) years. Of all the cultures sent for microbiological examination, 18.6% were positive. The proportion of Gram-negative bacteria causing PCNSIs was 91.6%. Multidrug-resistant (MDR) (41%) was the most common organism isolated. Among Gram-positive bacteria, the most common organism was (5.5%). All the Gram-positive isolates were susceptible to vancomycin, teicoplanin, and linezolid.
There is a high burden of PCNSI caused by MDR can pose a major clinical challenge with only few antimicrobials left in the pipeline.
本研究旨在调查神经侵入性手术后创伤患者术后中枢神经系统感染（PCNSIs）的患病率及致病微生物的抗生素耐药谱。
这是一项为期4年（2013 - 2017年）的回顾性研究。所有入住神经创伤科且符合PCNSIs纳入标准的住院患者均纳入研究。手术部位感染（SSIs）根据疾病控制与预防中心2018年（CDC）标准定义。我们回顾性检查了2013年1月至2017年12月开颅术后脑脊液培养阳性患者的人口统计学特征、神经外科手术类型、实验室数据、致病微生物及抗菌药物敏感性试验结果。
在研究期间接受手术的2500例患者中，961例接受了PCNSIs筛查。作为器官/腔隙SSI一种类型的PCNSIs的估计患病率（95%置信区间）为7.2%（6.3 - 8.3）。男性受影响为主（85.0%）。患者的平均年龄（标准差）为31.9（16.5）岁。所有送检微生物检查的培养物中，18.6%为阳性。引起PCNSIs的革兰氏阴性菌比例为91.6%。多重耐药（MDR）（41%）是最常见分离出的微生物。在革兰氏阳性菌中，最常见的微生物是（5.5%）。所有革兰氏阳性分离株对万古霉素、替考拉宁和利奈唑胺敏感。
由MDR引起的PCNSI负担较重，随着可用抗菌药物减少，可能构成重大临床挑战。
