济宁市某三甲医院神经外科术后感染特点及围术期抗菌药物使用评价

目的探讨济宁市某三甲医院神经外科术后感染的特点并对围术期抗菌药物使用合理性进行评价。方法采用回顾性研究的方法,选择济宁医学院附属医院2017年1月-2019年12月进行颅脑外科手术的患者作为研究对象,共纳入500例,对其病历资料进行收集。统计纳入患者发生感染总例数、总例次、发生部位、多部位感染情况;统计纳入患者感染病原及耐药性特征;统计围术期不合理用药情况及其原因。结果纳入的500例患者共有94例发生医院感染,感染率为18.80%,总感染例次103例,总例次感染率20.60%。医院感染部位以手术部位、呼吸道和泌尿道为主;送检标本共培养分离出病原菌110株,其中革兰阴性菌58株占52.73%,革兰阳性菌50株占45.45%,真菌2株占1.82%;主要革兰阴性菌铜绿假单胞菌对亚胺培南、美罗培南、氨曲南耐药率较高,对氨苄西林/舒巴坦、阿米卡星敏感性较高,肺炎克雷伯菌对氨曲南、头孢菌素、氨苄西林/舒巴坦耐药率较高,对亚胺培南、美罗培南、阿米卡星、左氧氟沙星敏感性较高;金黄色葡萄球菌和凝固酶阴性葡萄球菌对青霉素耐药率均为100.00%,对万古霉素、利奈唑胺较敏感;500例患者共发生不合理抗菌药物使用153例次占30.60%,涉及患者151例,发生率30.20%,不合理用药主要原因以开始给药时间不当、用法用量不规范和抗菌药物选择不当为主。结论神经外科医院感染以手术部位感染为主,革兰阴性菌检出率较高,不合理抗菌药物使用发生率较高,应加强针对性干预,规范抗菌药物使用。

Characteristics of infections after neurosurgery and evaluation of perioperative antibacterial use in a tertiary hospital of Jining

OBJECTIVE To investigate the characteristics of postoperative neurosurgery infection in a tertiary hospital in Jining city and evaluate the rationality of perioperative use of antibacterials. METHODS Using retrospective research methods, patients who underwent craniocerebral surgery from Jan. 2017 to Dec. 2019 in the affiliated hospital of Jining medical college were selected as the research subjects. A total of 500 cases were included and their medical records were collected. The total number of infections, the total number of cases, infection sites, and infection of multi-sites was included in statistics;characteristics of pathogen infection and drug resistance of patients were included in statistics;the irrational use of drug during the perioperative period and the reasons were counted. RESULTS A total of 94 cases of nosocomial infection occurred in the 500 patients enrolled, the infection rate was 18.80%, the total infection cases were 103 cases, and the total infection rate was 20.60%. The sites of nosocomial infection were mainly the surgical sites, respiratory tract and urinary tract. A total of 110 pathogenic bacteria were co-cultured and isolated from the submitted specimens, of which 58 strains of Gram-negative bacteria accounted for 52.73%, 50 strains of Gram-positive bacteria accounted for 45.45%, and 2 strtains of fungi accounted for 1.82%. Pseudomonas aeruginosa, the main Gram-negative bacteria, showed higher resistance to imipenem, meropenem and aztreonam, and comparative sensitivity to ampicillin/sulbactam and amikacin;Klebsiella pneumoniae showed higher resistance to aztreonam, cephalosporin and ampicillin/sulbactam, and comparative sensitivity to imipenem, meropenem, amikacin and levofloxacin as well. The resistant rates of Staphylococcus aureus and coagulase negative Staphylococcus to penicillin were both 100.00%, and were more sensitive to vancomycin and linezolid. There were 153 cases of irrational use of antibacterial drugs in 500 patients, accounting for 30.60%, and 151 patients were involved, with an incidence rate of 30.20%. The main reasons for the irrational use of antibacterial drugs were improper starting drug administration time, irregular useage and dosage, and improper selection of antibacterial drugs. CONCLUSION Nosocomial infection in neurosurgery department was mainly caused by infection at the surgical sites, and the detection rate of gram-negative bacteria was high, and the incidence of irrational use of antibacterial drugs was high. Targeted intervention should be strengthened to standardize the use of antibacterial drugs.