Correlation Analysis Of Intracranial Infection With Acinetobacter Baumannii After Operation

[Objective]:By collecting clinical data related to intracranial infection of Acinetobacter baumanii(Ab)after neurosurgery,the general information of patients and the isolation of Ab strain were statistically analyzed.Risk factors related to Ab intracranial infection after craniotomy,drug resistance of Ab strain and different treatment regimens after infection were analyzed,and the prognosis was statistically analyzed.It provides a theoretical basis for the prevention and treatment of postoperative Ab infection,drugs and treatment measures as well as the choice of the program,so as to improve the prognosis of patients.[Methods]:The Infection-related data of patients with intracranial infection after neurosurgical craniotomy in the First Affiliated Hospital of Kunming Medical University from January 2017 to September 2020 were analyzed.Clinical retrospective study was carried out including laboratory examination data and related clinical data.SPSS21.0 software was used to analyze the risk factors related to Ab infection after craniotomy.The efficacy of different treatment methods was evaluated.[Results]:1.There were 86 cerebrospinal fluid specimens of 71 patients Who has intracranial infection after craniotomy.Among them,3 strains of fungi were cultured in cerebrospinal fluid,accounting for 3.49%,Other strains like gram-negative bacilli,38 strains,accounting for 44.19%,Finally,there were gram-positive bacilli,45 strains were isolated from cerebrospinal fluid,accounting for 52.32%.Ab was the most isolated strain,followed by methicillin-resistant Staphylococcus Aureus(MRSA).This includes other Common bacteria such as Klebsiella pneumoniae,Staphylococcus haemolyticus,etc.the same time,In the case of intracranial Ab infection accompanied by pulmonary infection,the majority of Ab bacteria were detected in sputum culture.2.Univariate analysis showed that there are many reasons occur for Infection.Such as cerebrospinal fluid leakage at the surgical site,postoperative gastric tube placement time>6 days,the preoperative diagnosis was brain tumor,had emergency surgery before,postoperative tracheotomy and invasive ventilation were performed,the postoperative serum albumin content was less than 35g/L,had a lung infection after surgery,the number of operations was>2 times,After the surgery,the infection entered the intensive care unit are risk factors for patients infected with Ab after craniotomy.The results were obtained by multiple Logistic regression analysis is that the postoperative gastric tube placement time of>6 days(P=0.001,OR=33.144)and Patients diagnosed preoperatively with brain tumor(P=0.027,OR=12.874)were independent risk factors for those who have Ab infection in their cerebrospinal fluid after elective craniotomy.That is to say.The incidence of Ab infection in sick person with brain tumors after craniotomy was 33.144 times higher than that in patients diagnosed without brain tumors preoperatively.The risk of Ab infection was 12.874 times higher in patients who had a gastric tube in place for more than 6 days after craniotomy than in patients who had no gastric tube in place or had a gastric tube in place for less than 6 days.3.Antibiotic resistance of bacteria:The sensitivity of tigecy cline to Ab was higher than that of other antibiotics(95.8%),and the sensitivity of polymyxin to Ab was the highest(100%).The other drugs had high resistance rates.4.Treatment plan and prognosis:During the course of treatment,intravenous tigecy cline was administered as the cornerstone of treatment for patients.The sick person who combined application of lumbar cistern drainage+intrathecal injection of antibiotics+lateral ventricle puncture tube drainage for postoperative treatment have better therapeutic effect and not bad prognosis.Among the 26 cases of Ab infection,13 cases(13/26)had poor prognosis,with a poor outcome rate of 50%,and 6 cases(6/26)were cured,with a cure rate of 23%.[Conclusion]:1.Emergency surgery,postoperative pneumonia infection,admission to the intensive care unit,invasive ventilation,the total number of operations>2 times,postoperative gastric tube placement time>6 days,postoperative serum albumin decreased to less than 35g/L,postoperative surgery site cerebrospinal fluid leakage is the risk factors of postoperative Ab infection in neurosurgery.The postoperative gastric tube placement time was>6 days,and the preoperative diagnosis of brain tumor was an independent risk factor for Ab infection after neurosurgery.2.The Ab infection after craniotomy is mostly XDR or MDR,and the drug resistance rate is constantly increasing.There are few drugs available for treatment.3.The sensitivity rate of tigecycline is high and the treatment effect is good.Lumbar cistern drainage,intrathecal injection and ventricular puncture and drainage Can be used in combination with other antibiotics.