Risk Factors And Pathogens Analysis Of Hospital-acquired Pneumonia In Craniocerebral Operations

Objective： To investigate risk factors，pathogenic characteristics and drug resistanceof Hospital-acquired Pneumonia（HAP）after craniocerebral operations in order toprovide basis for clinical prevention and cure.Methods：583case craniocerebral operations’ patients were analyzed，surveyingrisk factors of HAP by multivariate logistic regression analysis，and collecting data ofHAP about sputum culture and drug susceptibility test.Results：347patients were male（59.5%），the mean age was47.1±16.8years，236patients were female（40.5%），the mean age was47.4±16.1years，there wasno statistical difference of the mean age between male and female（P＞0.05）.110episodes underlying disease in97patients（16.6%），the common disease was highblood pressure67episodes（55.45%）,diabetes mellitus18episodes(16.36%),hepatitis B virus8episodes (7.28%). The common disease ofCranium and brain was meningioma116episodes(15.7%), skull fracture79episodes(10.7%), brain injury76episodes (10.3%).57patients（9.78%）developedHAP，the mean age of HAP was50.8±14.6years，40patients were male，17patients were female，there was no statistical difference of age and gender betweenHAP cohort and non-HAP cohort （P＞0.05）.3patients （5.26%）of HAP died.Univariate analysis identified the following factors：underlying medical condition，craniocerebral injury，emergency operation，combined anesthesia，tracheotomy，endotracheal intubation，nasogastric tube，mechanical ventilation，commencing enteral feeding＞1day，proton pump inhibitor，antiepileptic drug（lunimal andsodium valproate），glucocorticoid，blood transfusion，hypoproteinaemia， AcutePhysiological and Chronic Health Evaluation II（APACHEII）score≥20，Grade ofGlasgow Coma Score（GCS）（P＜0.05）. Multivariate analysis identified threeindependent risk factors for HAP in craniocerebral operations:tracheotomy（OR=16.005,95%CI=5.847-43.807）, nasogastric tube （OR=4.026,95%CI=1.426-11.362）and grade of GCS（OR=2.808,95%CI=1.659-4.754）. There were172episodes of pathogens，140Gram-negative bacteria（81.40%）were the majorpathogen，there were62Acinetobacter baumanii（36.0%），26K.pneumoniae（15.1%）and22Pseudomonas aeruginosa（12.8%）strains. There were23Gram-positive bacteria strains（13.4%）.In Gram-positive bacteria，17Staphylococcusaureus(9.9%) were the major pathogen including6strains fo Methicillin-resistantStaphylococcus aureus(MRSA)(3.5%). The sensitivity was lower than50percent of toall anti-microbial drugs about Acinetobacter baumanii，there was imipenem/cilastatin-resistant Acinetobacter baumanii. The drug fast ratio of methicillin-susceptiblestaphylococcus aureus（MSSA）and MRSA was100percent to clindamycin, thesensitivity was100percent to vancomycin，linezolid and nitrofurantom of MRSA.Conclusions：The morbidity rate of HAP after craniocerebral operations was high butthe fatality rate was low. The risk factors of HAP after craniocerebral operations weretracheotomy，nasogastric tube and level of disorder of consciousness. Gram-negativebacteria was the major pathogen of HAP，especially Acinetobacter baumanii,the rateof its multi-drug-resistance was very high，meanwhile imipenem/cilastatin-resistantAcinetobacter baumanii was appearing. Staphylococcus aureus were the major pathogenin Gram-positive bacteria，were resistant to clindamycin completely.