Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
Neurosurg Rev. 2023 Aug 12;46(1):199. doi: 10.1007/s10143-023-02106-0.
The objective of this study was to determine risk factors of pejorative evolution course in patients suffering from postoperative cranial infection. The data of patients who developed an intracranial infection after craniocerebral surgery in the neurosurgical intensive care unit of the First Affiliated Hospital of Nanjing Medical University in Nanjing, Jiangsu, China, from February 2018 to August 2019 were retrospectively analyzed. Logistic regression was used to analyze the factors influencing the prognosis of intracranial infection treatment. Sixty-four patients developed an infection after craniocerebral surgery, and 48 of them with negative CSF cultures received experimental anti-infectives. In 16 patients, cerebrospinal fluid culture showed pandrug-resistant pathogens, including 11 Acinetobacter baumannii (11), Klebsiella pneumoniae (3), Escherichia coli (1), and Candida glabrata (1). Nine patients received intraventricular or intrathecal injections of polymyxin B. The mean duration of infection treatment was 22.2 ± 9.9 days, and the clinical cure rate was 85.9% (55/64). Logistic multivariate regression analysis showed that inadequate CSF drainage (OR, 6.839; 95% CI, 1.130-41.383; P = 0.036) and infection with drug-resistant bacteria (OR, 24.241; 95% CI, 2.032-289.150; P = 0.012) were independent risk factors for postoperative intracranial infection. Intracranial infection with positive CSF culture and inadequate CSF drainage are factors contributing to the poor prognosis of intracranial infection. Moreover, early anti-infection treatment and adequate CSF drainage may improve patient outcomes. In particular, intraventricular or intrathecal injection of polymyxin B may be a safe and effective treatment strategy for MDR/XDR gram-negative bacilli infection.
本研究旨在确定术后颅脑感染患者病情恶化的危险因素。对 2018 年 2 月至 2019 年 8 月期间在南京医科大学第一附属医院神经外科重症监护病房发生颅内感染的颅脑手术后患者的数据进行了回顾性分析。采用 Logistic 回归分析影响颅内感染治疗预后的因素。64 例患者发生颅脑手术后感染，其中 48 例脑脊液培养阴性的患者接受了经验性抗感染治疗。16 例患者的脑脊液培养显示为泛耐药病原体，包括鲍曼不动杆菌 11 株（11 株）、肺炎克雷伯菌 3 株、大肠埃希菌 1 株和光滑假丝酵母菌 1 株。9 例患者接受了脑室或椎管内注射多黏菌素 B。感染治疗的平均时间为 22.2±9.9 天，临床治愈率为 85.9%（55/64）。Logistic 多变量回归分析显示，脑脊液引流不足（OR，6.839；95%CI，1.130-41.383；P=0.036）和耐药菌感染（OR，24.241；95%CI，2.032-289.150；P=0.012）是术后颅内感染的独立危险因素。CSF 培养阳性和脑脊液引流不足的颅内感染是导致颅内感染预后不良的因素。此外，早期抗感染治疗和充分的脑脊液引流可能改善患者的预后。特别是脑室或椎管内注射多黏菌素 B 可能是治疗 MDR/XDR 革兰氏阴性杆菌感染的一种安全有效的治疗策略。
