Etiological Characteristics And Risk Factors Of Intracranial Infection After Craniotomy In Patients With Diabetes Mellitus And Hypertension

Objective:To analyze the pathogenic characteristics and risk factors of intracranial infection in patients with diabetes and hypertension after craniotomy.Methods:100 patients with diabetes and hypertension who underwent craniotomy in our hospital from June 2018 to January 2023 were selected.The clinical data of the patients were retrospectively analyzed.The cerebrospinal fluid collected by lumbar puncture was separated and identified.The pathogenic characteristics of intracranial infection after craniotomy and the related factors of infection risk were analyzed.Results:There were 28 cases of intracranial infection after craniotomy in 100 patients with diabetes and hypertension,the infection rate was 28.00%.A total of 32 strains of pathogenic bacteria were isolated,including 19 cases of Gram positive bacteria,accounting for 59.38%,and 13 cases of Gram negative bacteria,accounting for 40.63%;Among Gram positive bacteria,there were 5 cases of Staphylococcus epidermidis,accounting for 15.63%,9 cases of Staphylococcus aureus,accounting for 28.13%,3 cases of Enterococcus faecium,accounting for 9.38%,and 1 case of other strains,accounting for3.13%;Among gram negative bacteria,there were 6 cases of Klebsiella pneumoniae(18.75%),3 cases of Pseudomonas aeruginosa(9.38%),2 cases of Acinetobacter baumannii(6.25%),1 case of Escherichia coli(3.13%),and 1 case of other strains(3.13%).The main pathogens of intracranial infection after surgery were gram positive bacteria;Among Gram positive bacteria,Staphylococcus aureus had high resistance rates to erythromycin,penicillin and tetracycline,which were 88.89%,100.00% and 66.67%respectively;The resistance rates to levofloxacin,teicoplanin and ciprofloxacin were11.11%,0.00% and 11.11%,respectively.The resistance rates of staphylococcus epidermidis to penicillin,tetracycline and erythromycin were 77.78%,100.00% and44.44%,respectively;The resistance rates to levofloxacin,clindamycin,teicoplanin and ciprofloxacin were 22.22%,22.22%,0.00% and 22.22%,respectively;Among gram-negative bacteria,Klebsiella pneumoniae had high resistance rates to cefuroxime and ampicillin,which were 100.00% and 83.33% respectively;The resistance rates to meropenem and imipenem were 16.67% and 0.00%,respectively;Pseudomonas aeruginosa had high resistance rates to ampicillin and cefuroxime,which were 100.00%and 100.00% respectively,and low resistance rates to ceftazidime,ceftriaxone,cefotaxime,levofloxacin,ciprofloxacin and meropenem,which were 33.33%.Conclusion:The main pathogens of intracranial infection after craniotomy are Gram positive bacteria.Rational use of antibiotics according to the characteristics of pathogens and drug resistance analysis can reduce the incidence of intracranial infection after craniotomy.The independent risk factors of intracranial infection after craniotomy are preoperative GCS score,preoperative albumin,operation time,presence of cerebrospinal fluid leakage,prophylactic use of antibiotics,placement of drainage tube,postoperative hyperglycemia,surgery under the tentorium,mastoid air chamber or sinus opening.The prevention of risk factors by adopting corresponding countermeasures is of positive significance to reduce the infection rate and improve the prognosis of patients.