Clinical Characteristics And Risk Factors Of Neurosurgical Severe Patients With The Hospital Acquired Pneumonia

Background: Hospital-acquired pneumonia(HAP)refers to the inflammation of the lung parenchyma that occurs 48 hours after admission,and the patient does not exist or is in the incubation period of pneumonia infection at the time of admission,which can be caused by pathogens such as bacteria and fungi.HAP is one of the serious complications of neurosurgery and is considered the deadliest and most expensive nosocomial infection worldwide.HAP infection can aggravate the disease and even directly lead to the death of the patient.Medical institutions at all levels pay more and more attention to this issue.In recent years,although the advancement of medical technology and equipment and the standardization of aseptic operation have significantly reduced the intracranial infection(ICI)in neurosurgery,there is no downward trend in neurosurgery HAP,and its morbidity and mortality are still the highest in neurosurgery.Complications first.The 2018 edition of the Chinese HAP treatment guidelines pointed out that the incidence of HAP and the composition of the flora in different regions of my country vary greatly.Previous studies on the general population showed that among the departments,the density of HAP in the intensive care unit(ICU)was the highest(3.01%),followed by neurosurgery(1.87%).In previous studies on stroke-related pneumonia,the incidence of HAP was as high as 6%-20%.It can be seen that the results of HAP studies for different populations vary greatly,which further confirms the point clearly stated in the guideline: "In empirical treatment,monitoring,understanding,updating and studying the etiological information of specific regions is particularly important,rather than blindly.It is a simple and crude application of previous research results." Neurosurgery ward has its own unique characteristics,such as: a wide variety of diseases in neurosurgery inpatients,a large proportion of neurosurgery patients in tertiary hospitals,and neurosurgeons are more inclined to use prophylactic antibiotics Wait.Therefore,the research on HAP infection in critically ill neurosurgery patients has strong generality and great significance.Objective: According to the spirit of the "Guide",the characteristics of HAP in this specific group of critically ill neurosurgery patients were studied and analyzed,including: risk factors related to HAP infection,distribution of pathogenic bacteria and antibiotic resistance.In order to avoid the high-risk factors of HAP infection in neurosurgery work,more accurate empirical anti-infective treatment,individualized and precise treatment.Methods : Patients with severe neurological diseases who were hospitalized in the neurosurgery department of a tertiary hospital from May 2019 to December 2019 were selected as the research objects.According to the diagnostic criteria issued by the American Thoracic Society(ATS),the patients were divided into HAP infection group and non-HAP infection group.Record and analyze the general information of patients(including gender,age,smoking history,aspiration history,disturbance of consciousness,ventilator-assisted breathing,indwelling gastric tube,etc.).Univariate analysis was performed using R version3.5.3 software for χ2 test.The enumeration data were expressed as the number of cases(n)and rate(%),and P<0.05 was considered statistically significant;Cramer’s V was also calculated to express the correlation of risk factors.The factors with statistical significance in univariate analysis were included in multivariate logistic regression model analysis.α=0.05 was the test level,and P<0.05 was considered statistically significant.The associated weight coefficients,OR values and 95% confidence intervals of risk factors were calculated.To screen out risk factors independently associated with HAP infection in critically ill neurosurgery patients.The sputum deep in the airway was collected from the HAP infection group for culture,and the distribution characteristics of pathogenic bacteria and the results of drug susceptibility tests were analyzed,and compared with the multi-center sampling research data of the previous 2018 version of the domestic HAP guideline.Results: A total of 176 subjects were included in this research group.Among them,57 cases were complicated with HAP during hospitalization,and the infection rate was 32.39%.Elder age factors(≥65years),previous smoking history,history of aspiration during treatment,history of hypertension,history of diabetes,whether there is hypoalbuminemia after this admission and before the occurrence of HAP,whether ventilator-assisted breathing,whether there is a disturbance of consciousness or not,whether the indwelling gastric tube was used or not was a risk factor related to HAP infection in neurosurgical severe patients(P<0.05).Among them,advanced age,smoking history,history of aspiration,history of hypertension,hypoalbuminemia after the admission and before the occurrence of HAP,whether there is hypoalbuminemia,indwelling gastric tube,disturbance of consciousness,application of ventilator are independently related to HAP infection in neurosurgical severe patients risk factors(P<0.05).Consciousness disturbance was most associated with HAP infection in critically ill neurosurgical patients.A total of 72 pathogenic strains were cultured from the above HAP-infected patients(the same pathogenic strain that appeared multiple times in the test results of the same patient was regarded as 1 strain),including 3 G+ strains(4.17%)and 57 G-strains(79.17%)and 12 fungi strains(16.67%).Among all pathogenic bacteria,Klebsiella pneumoniae accounted for the highest proportion(22.22%).In the drug susceptibility test,the total sensitivity rate of amikacin was 88.24%,the total sensitivity rate of meropenem and imipenem were both86.27%,and the total sensitivity rates of moxifloxacin and levofloxacin were 55.1% and 54.9%,respectively.Conclusion: 1.The independent risk factors of HAP infection in critically ill neurosurgery patients are different from previous studies on HAP in the general population: disturbance of consciousness is most closely related to it,advanced age,history of smoking,history of aspiration,hypertension,and the duration of treatment.Hypoalbuminemia,ventilator-assisted breathing,and indwelling gastric tube were independently associated with it.2.Compared with previous HAP studies on the general population,severe neurosurgery patients with HAP infection have a higher proportion of Klebsiella pneumoniae,a higher proportion of fungal superinfection,and a very low detection rate of Staphylococcus aureus.3.Amikacin,meropenem,imipenem,cefoperazone and sulbactam sodium have a good sensitivity rate to common pathogens of HAP infection in severe neurosurgery patients.