Risk Factors And Pathogens Of Severe And Non-severe Pneumonia In Patients Undergoing Neurosurgery Surgery

Objective:Pulmonary infection is a common complication in patients with craniofacial surgery,which not only worsens the condition,but can also lead to respiratory failure and eventual death.Severe pneumonia(SP)is formed by increased inflammatory progression in lung tissue,which can cause severe sepsis and infectious shock.This study aims to analyze the situation of SP patients with craniocerebral surgery,to explore the related risk factors and pathogenic bacteria of patients with craniocerebral surgery,and further propose relevant prevention and treatment strategies to provide a scientific basisstrategies to provide scientific basis and clinical guidance for the prevention and treatment of postoperative patients to merge SP.Methods:Through retrospective analysis,clinical data of patients with cerebral surgery complicated with pneumonia were collected from January 2019 to December 2019.The information collected included basic information,underlying disease,type and duration of surgery,invasive procedures,post-hospitalization blood routine,C-reactive protein(CRP),procalcitonin(PCT),bacterial culture of sputumand drug sensitivity results.After the data are collated and verified,SPSS 23.0 was used for statistical analysis.Results:There were 623 patients with craniocerebral surgery combined with craniocerebral surgery combined with pneumonia,including 78 patients in SP group and 545 patients in non-SP group.In the SP group,9 cases(11.54%)of ARDS,1case(1.28%)of sepsis with ARDS,21 cases(26.92%)of acute renal insufficiency,and 28 cases(35.90%)of acute cardiac dysfunction occurred.In the SP group,59cases(75.64%)were cured and 8 cases(10.26%)died,while in the non-SP group,527 cases(96.69%)were cured and 6 cases(1.11%)died.Patients in both groups had fever,cough and expectotic,and the duration of fever and heat peak in SP group were longer and higher than those in non-SP group [(5.38±2.76)d VS(2.34±1.89)d;(39.43±1.87)℃ VS(38.34±0.45)℃,P < 0.05].The increase in neutrophil count,CRP,and PCT was most significant in both groups during the second week of hospitalization,they were higher in SP groupthan those in non-SP group [(21.75 ±14.87)*109/L VS(15.43 ± 10.49)*109/L;(96.78 ± 74.69)mg/L VS(48.43 ±67.23)mg/L;(7.23 ± 5.32)ng/m L VS(3.34 ± 6.34)ng/m L,all P < 0.05].Univariate analysis identified the following factors: age,smoking,underlying disease(hypertension,diabetes,cardiac insufficiency,coronary heart disease and chronic obstructive pulmonary disease),hypoproteinemia,emergency surgery,endotracheal intubation,tracheotomy,mechanical ventilation,and Glasgow Coma Score(GCS)score were associated with the occurrence of SP in patients undergoing craniocerebral surgery,(all P<0.05).Multivariate analysis identified four independent risk factors for SP in craniocerebral operations:smoking(OR=64.153,95%CI=7.137-576.689),baisc-diseases(OR=13.678,95%CI=1.584-15.376)and grade of GCS(OR=2.836,95%CI=1.874-5.849).The pathogenic results showed that G-bacterias were the main cause of pneumonia in both groups.In non-SP group,klebsiella pneumoniae,Escherichia coli and Pseudomonas aeruginosa were the main bacterias,while acinetobacter baumannii,Pseudomonas aeruginosa and Burkholderia onion were the main bacterias in group SP.The G+ bacteria infection was staphylococcus aureus in both groups,but 7 strains(3.12%)of methicillin-resistant sensitive Staphylococcus aureus(MRSA)were found in SP group.Some SP patients also had fungal infection.The sensitivity was lower than 50 percent of to all anti-microbial drugs about Acinetobacter baumanii.The drug fast ratio of MRSA was 100% to clindamycin.All fungi were sensitive to amphotericin B,fluconazole,itraconazole,voriconazole and fluorocytosine.Conclusion:The complications and fatality rate,fever days,heat peak,CRP and PCT of SP patients undergoing craniocerebral surgery were higher than those of non-SP patients.Multivariate risk analysis showed that smoking history,underlying diseases and the degree of coma were independent risk factors for SP during craniocerebral surgery.The pathogens of SP related to craniocerebral surgery are mainly G-bacteria,of which Bowman’s immobilized bacteria are most common and show multiple drug resistance.The pathogens associated with cranial brain surgery are mainly G-bacteria,Some SP patients also have fungal infections.All fungi are sensitive to amphotericin B,fluconazole,itraconazole,voriconazole and flucytosine.