Clinic Study Of The Treatment For The Neurosurgical Intracraniocerebral Infection By Intrathecal Injection With Antibiotic

Objection:To investigate the dangerous factors of the intracraniocerebral infection, and then establish the criterion for the potential surgical intracranial infection.To assess the optimal method,time and the confirmed intracranial infection by intrathecal injection with antibiotic.All results of the studies were used to instruct the works of the clinic.Method:Firstly 3396 patients who had accepted neurosurgical operations from 2004～2006 were analyzed retrospectively.There were 106 patients had suffered intracranial infection.Several factors possible relate to intracranial infection were investigated,including sex,age,entity,the operation duration,method of operations, have CSF fistulae,ventricle drainage,the insertion of drainage tube,opened or closed craniocerebral injuries,having diabetes before the operation,season and so on.A date-base was set up with spss 11.0 for Windows and X~2-test were selected to analysis the dangerous factors that may initiate intracranial infection.Referencing to the Harrison's criterion for intracranial infection,we establish the criterion for the potential intracranial infection.Secondly we select the sensitive antibiotic basing on the features of microbial population of the patients with intracranial infection.183 neurosurgical patients who accepted craniotomy and with surgical potential intracranial infection were divided into group A or B by turns thirdly.All patients were treated with cafatadine in vein,but only 91 cases of A group were treated with ceftazidime by intrathecal injection,and 92 cases of B group were treated with tales doses normal sodium as contral.10cases were taken from every group,and the drug concentrations of ceftazidime in the drainaged CSF from wound surfaces of them were detected.Results:There were 106 patients who had suffered intracranial infection,including 69 men and 37 women during the three years from 2004 to 2006.The statistical analysis demonstrate that the opened craniocerebral injuries,having CSF fistulae, ventricle drainage,the insertion of drainage tube,having accepted more one operations during in hospital and the longer time had been taken by operations were the very dangerous factors of intracranial infection.It also demonstrate that the sex, the age,being or not being emergence,the regular administration of the hormone,the administrating antibiotic before operations,the seasons have no correlation to the intracranial infection.The five susceptible microbials that cause to intracranial infection were Staphylococcus aureus,Streptococcus pneumoniae,Pseudomonas aeruginosa,E coli, Klebsiella pneumoniae.All the five microbials are in the antibacterial spectrum of the ceftazidime.In the study of the intrathecal injection with ceftazidime,there were only 8 patients of A group developed into intracranial infection,but there were 26 cases which developed into intracranial infection in the B group.The drug concentration of ceftazidime in the drainaged CSF from A group only was 1.2μg/ml and beyond the1.0μg/mlMIC. Conclusion: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.It is effective to prevent the occurring of intracranial infection by intrathecal injection with ceftazidime on potential cases which accepted craniotomy.