鲍曼不动杆菌医院感染调查及头孢哌酮/舒巴坦钠治疗颅内感染序贯治疗的临床分析。
The Investigation on Nosocomial Infection of Acinetobacter baumannii and the Clinical Analysis of Sequential Therapy of Cefoperazone/Sulbactam Sodium for Intracranial Infection.
机构信息
Intensive Care Unit Part 1, Qinzhou Second People's Hospital, Guangxi, Qinzhou 535000, China.
出版信息
Comput Math Methods Med. 2022 Aug 16;2022:4525892. doi: 10.1155/2022/4525892. eCollection 2022.
BACKGROUND
Intracranial infection is a serious complication after neurosurgery. According to a survey, the incidence of intracranial infection is about 2.2%-2.6%, and patients with severe symptoms may even pose a threat to their life safety.
OBJECTIVE
To explore the risk factors for intracranial infection caused by Acinetobacter baumannii after surgery and the clinical effect of sequential therapy of cefoperazone/sulbactam sodium.
METHODS
In this study, a retrospective study was used. In this case-control study, 48 cases of intracranial Acinetobacter baumannii infection after neurosurgery in our hospital from January 2016 to December 2021 were selected as the infection group, and 96 patients without intracranial infection after surgery during the same period were selected as the control group to study all kinds of related factors and analyze the risk factors for intracranial Acinetobacter baumannii infection; in addition, in accordance with the therapeutic regimen for anti-infection, the infection group was divided into the tigecycline group (patients with tigecycline therapy in this group) and the combined group (patients with tigecycline combined with cefoperazone/sulbactam sequential therapy), with 24 cases in each group in order to compare the therapeutic effects of the two groups.
RESULTS
Logistic regression factor model results show that increasing age of patients, surgical treatment for intracranial tumor or craniocerebral trauma, postoperative drainage time (≥3 days), and postoperative hospital stay (≥10 days) were the risk factors for postoperative intracranial infection of Acinetobacter baumannii in neurosurgical patients ( < 0.05), and postoperative prophylactic antibiotic treatment can reduce the incidence of intracranial infection ( < 0.05). The cerebrospinal fluid nucleated cell count, serum CRP, and serum PCT in the combined group 72 h after treatment were lower than those in the tigecycline group, and the difference was statistically significant ( < 0.05). Compared with the clinical efficacy after 72-hour treatment, the cure rate and effective rate in the combined treatment group were 83.33% and 16.67%, respectively, and those in the tigecycline group were 54.17% and 33.33%, respectively. The invalid interest rate was 12.50%, and the combined treatment group was superior to the tigecycline group ( < 0.05).
CONCLUSION
For patients with craniocerebral surgery, targeted preventive interventions should be carried out for the risk factors that may lead to intracranial Acinetobacter baumannii infection. The clinical effect of tigecycline combined with cefoperazone and sulbactam sodium sequentially in the treatment of intracranial Acinetobacter baumannii infection is better.
背景
颅内感染是神经外科术后的严重并发症。据调查，颅内感染的发生率约为 2.2%-2.6%，严重者甚至可能危及生命安全。
目的
探讨神经外科术后鲍曼不动杆菌引起颅内感染的危险因素及头孢哌酮/舒巴坦钠序贯治疗的临床效果。
方法
采用回顾性研究方法。本病例对照研究选取 2016 年 1 月至 2021 年 12 月我院神经外科术后颅内鲍曼不动杆菌感染患者 48 例作为感染组，同期无颅内感染的手术患者 96 例作为对照组，研究各种相关因素，并分析颅内鲍曼不动杆菌感染的危险因素；另外，根据抗感染治疗方案，将感染组分为替加环素组（替加环素治疗组）和联合组（替加环素联合头孢哌酮/舒巴坦钠序贯治疗组），每组 24 例，比较两组的治疗效果。
结果
Logistic 回归因素模型结果显示，患者年龄增长、颅内肿瘤或颅脑创伤手术治疗、术后引流时间（≥3d）、术后住院时间（≥10d）是神经外科患者术后鲍曼不动杆菌颅内感染的危险因素（ < 0.05），术后预防性应用抗生素治疗可降低颅内感染发生率（ < 0.05）。治疗后 72h 时，联合组患者的脑脊液有核细胞计数、血清 CRP、血清 PCT 均低于替加环素组，差异有统计学意义（ < 0.05）。与治疗后 72h 的临床疗效比较，联合组的治愈率和有效率分别为 83.33%、16.67%，替加环素组分别为 54.17%、33.33%，无效率为 12.50%，联合组优于替加环素组（ < 0.05）。
结论
针对可能导致颅内鲍曼不动杆菌感染的危险因素，对行颅脑手术的患者应进行有针对性的预防干预。头孢哌酮/舒巴坦钠序贯联合替加环素治疗颅内鲍曼不动杆菌感染的临床效果较好。
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