CAJ | 학술논문

目的：研究神经外科手术患者术后颅内感染病原菌及耐药性，为神经外科患者术后颅内感染治疗提供参考。方法选取2008年1月－2013年12月医院收治的800例神经外科手术患者作为研究对象，随机抽取新入院38例患者，对其手术第1、2、4、7天时头皮标本以常规方法进行病原菌及培养药敏结果，同时对感染患者的脑脊液检出的病原菌和药物敏感性进行分析。结果800例神经外科手术患者共发生颅内感染50例，感染率6．25％；脑脊液培养出病原菌50株，以革兰阳性菌为主，共39株占78．00％；38例患者头皮培养检出病原菌146株，其中革兰阳性菌最多，其次为真菌及革兰阴性杆菌，分别占91．78％、4．11％及4．11％；患者脑脊液及头皮检出的革兰阳性菌对苯唑西林、青霉素的耐药率均较高，分别为87．18％、84．62％及94．78％、100．00％，对万古霉素耐药率均较低；脑脊液检出的革兰阴性菌对卡那霉素的耐药率最高，为54．55％，头皮检出的革兰阴性菌对头孢吡肟及头孢他啶的耐药率最高，均为100．00％。结论神经外科术后患者发生颅内感染由多种因素造成，脑脊液及头皮拭子培养均以革兰阳性菌多见，但局灶性颅内逆行感染是神经外科患者发生感染影响最大的因素。
목적：연구신경외과수술환자술후로내감염병원균급내약성，위신경외과환자술후로내감염치료제공삼고。방법선취2008년1월－2013년12월의원수치적800례신경외과수술환자작위연구대상，수궤추취신입원38례환자，대기수술제1、2、4、7천시두피표본이상규방법진행병원균급배양약민결과，동시대감염환자적뇌척액검출적병원균화약물민감성진행분석。결과800례신경외과수술환자공발생로내감염50례，감염솔6．25％；뇌척액배양출병원균50주，이혁란양성균위주，공39주점78．00％；38례환자두피배양검출병원균146주，기중혁란양성균최다，기차위진균급혁란음성간균，분별점91．78％、4．11％급4．11％；환자뇌척액급두피검출적혁란양성균대분서서림、청매소적내약솔균교고，분별위87．18％、84．62％급94．78％、100．00％，대만고매소내약솔균교저；뇌척액검출적혁란음성균대잡나매소적내약솔최고，위54．55％，두피검출적혁란음성균대두포필우급두포타정적내약솔최고，균위100．00％。결론신경외과술후환자발생로내감염유다충인소조성，뇌척액급두피식자배양균이혁란양성균다견，단국조성로내역행감염시신경외과환자발생감염영향최대적인소。
OBJECTIVE To investigate the pathogens and drug resistance of postoperative intracranial infections in neurosurgical patients ,so as to provide reference for treatment of postoperative intracranial infectiond in neurosur‐gical patients .METHODS Totally 800 cases of neurosurgical patients from Jan .2008 to Dec .2013 in our hospital were selected as research subjects .And 38 patients newly admitted to hospital were randomly selected to observe the culture and sensitivity results of scalp samples by conventional method at postoperative 1 ,2 ,4 ,7 days ,mean‐while ,pathogens and drug sensitivity of cerebrospinal fluid (CSF) from infected patients were analyzed .RESULTS Totally 50 out of 800 neurosurgical patients had intracranial infections with the infection rate of 6 .25% .The CSF culture detected 50 pathogens mainly including gram positive bacteria (39 strains ,78 .00% ) .The scalp culture for 38 patients detected 146 pathogens mainly including gram positive bacteria (91 .78% ) ,followed by fungi (4 .11% ) and gram negative bacilli (4 .11% ) .Gram positive bacteria from CSF and scalps had high resistances to oxacillin and penicillin ,with resistances of 87 .18% ,84 .62% and 94 .78% ,100 .00% ,while their resistances were low to vancomycin .Gram negative bacteria from CSF had the highest resistance of up to 54 .55% to kanamycin ,while gram negative bacteria from scalps were most resistant to cefepime and ceftazidime with resistances of 100 .00% . CONCLUSION Postoperative intracranial infections in neurosurgical patients is caused by several factors .For neu‐rosurgical patients ,gram positive bacteria are common in CSF and scalp swab culture ,but the focal retrograde in‐tracranial infection is the greatest factor affecting infections in neurosurgical patients .