A Study About Postoperative Intracranial Infections In Neurosurgery

Objective: To analyse correlation factors of postoperative intracranial infections in neurosurgery and guide rational use of antibiotics in clinic according to distribution of durg resistant strain in the hospital.Objects and Methods: 1083 neurosurgical patients who had a neurosurgicaloperation in half of operative patients in 2005 were choosen randomly(105 cases with intracranial infection). 16 possible related factors werestudied retrospectively, including sex, age, entity, the operationduration(with the exception of local anesthesia operation), method ofoperation, having CSF fistulae, ventricle drainage, the insertion ofdrainage tube(with the exception of ventricle drainage,ventriculoperitoneal shunt and interventional therapy), emergencyoperation, open or closed craniocerebral injuries, having diabetesbefore the operation, having hypertension before operation, preoperativeapplication of hormones and antibiotics, postoperative application ofantibiotics and season. A date-base was set up with SPSS12. 0 for Windows,and Logistic regression was selected to analysis the factors that maycause infection. 30 patients hospitalized newly in April 2006 werechoosen. Scalp were collected in the first day, the second day, the forthday, the sixth day and bacterial culture was performed. Status of strainsdistribution was analyzed and residence time of strains was observed.Suitable operative time was analyzed and clinical antibiotic prophylaxiswas guided according to the results. Status of strains distribution inneurosurgery in 2005 was concluded and contrasted with result of CSF bacterial culture and clinical antibiotic prophylaxis was guided according to the results.Results: The analysis of 1083 cases(male 673, female 410)revealed that postoperative intracranial infection rate was related to the age, entity, the operation duration (with the exception of local anesthesia operation), method of operation, having CSF fistulae, ventricle drainage, the insertion of drainage tube(with the exception of ventricle drainage, ventriculoperitoneal shunt and interventional therapy), emergency operation, open or closed craniocerebral injuries, having diabetes before the operation. While had no effect on sex, having hypertension before operation, preoperative application of hormone and antibiotics, postoperative application of antibiotics and season. The most five strains in Huanhu Hospital in turn are klebsiella pneumoniae, staphylococcus aureus, E.coli, staphylococcus epidermidis and pseudomonas aeruginosa. The most five strains of CSF culture in turn are klebsiella pneumoniae, staphylococcus epidermidis, staphylococcus aureus, E.coli and pseudomonas aeruginosa. The two results are the same on the whole. The results of 30 bacterial cultures of scalp are as follows: no one in the first day, three in the second day, eighteen in the third to forth day, twenty eight in the fifth to sixth day, twelve cases with staphylococcus epidermidis, nine cases with staphylococcus aureus, three cases with micrococcus, two cases with E. coli, one case with klebsiella pneumoniae and acinetobacter baumanii.Conclusions: Postoperative intracranial infections of neurosurgery involve in many factors. Patients with impossible resistance factors such as age, entity, the operation duration, emergency operation and having diabetes before operation should be payed more attention to the aseptic technique and antibiotic prophylaxis. Other predisposing factors such as CSF fistulae, ventricle drainage and the insertion of drainage tube can be controlled as far as possible by means of complete suturation and time control of ventricle drainage and the insertion of drainage tube. The result of hospital onset of infection in neurosurgery in 2005 showed Gram-negative bacteria was main. But the result of bacteria culture of scalp showed Gram-positive bacteria was main. So we think infections during the operation was chiefly Gram-positive bacteria and infections after operation was chiefly Gram-negative bacteria. So antibiotic prophylaxis can be adopted as follows: antibiotics that effect on Gram-positive bactetia should be select during the operation and antibiotics that effect on Gram-negative bacteria should be select after operation.