| OBJECTIVE To investigate the clinical manifestations, bacterial resistance to drugs and find the risk factors of staphylococcic meningitis associated with post-craniotomy, so the prophylactic measures and therapy maybe defined.METHOD A retrospective study of the patients, who were performed neurosurgical operations between Sep,1999 and Sep,2007 in Qilu Hospital of Shandong University, was made. Staphylococcus was cultured from the cerebrospinal fluid of every case. The age, sexuality, operation, temperature, complicated bacteria, the biochemical and cultural results of the cerebrospinal fluid, effictive and resistant antibiotics, therapy and the prognosis were recorded. All of the numerical materials were analyzed by the famous statistic software SPSS of versionl3.0.RESULTS There were 30 patients in this series: 16 males, 14 females, age 2-72y, mean age 39.5y. 33 bacteria were found, including 27 Staphylococcus epidermidis, 4 Staphylococcus haemolyticus, 1 Staphylococcus aureus and 1 Staphylococcus saprophyticus. 9 cases were infected by more than two bacteria, involving 7 Gram-negtive bateria. 22 bacteria were resistant to meticillin containing 18 Staphylococcus epidermidis, 3 Staphylococcus haemolyticus and 1 Staphylococcus aureus. The general isolating rate of the methicilin resistant Staphylococcus was as high as 66.7%. 11 of 4661 patients performed operations for intracranial tumors, 5 of 787 for craniocerebral trauma, 11 of 865 for cerebrospinal fluid shunt or external ventrical drainage( including 2 tumors ), and 5 of 865 for other kinds of operations were detected with the morbidity of 0.24%, 0.64%, 1.90%, and 0.69% respectively. There was significant difference between the third and the first or the fourth group (P<0.05).The temperature of 2 patients was higher than 40.1℃, 23 between 39.1℃and 40℃, 4 between 38.1℃and 39.0℃, just 1 below 38.0℃, with the average of 39.4±0.6℃. The temperatures of 22 patients of the 1st day after the operation were higer than 38.0℃. 17 cases had the higest temperature in 9 days, 7 in 10-19d, 3 in 20-29d, 1 in 30-39d and 2 cases more than 60d. The time between the operation and the highest tempareture of staphyloccus epidermidis was 15.7±15.9d, while was not significantly shorter than that of Staphylococcus haemolyticus of 21.0±8.0d (P=0.646>0.05).The positive cultured time of staphylococci was betwteen 3d and 190d, average 28.6±42.3d, 10 cases less than 9d, 8 cases in 10-19d, 5 in 20-29, 3 in 30-39, 2 in 40-100d and more than 100d respectively. There was no significant difference between that of the staphyloccus epidermidis and the staphyloccus haeolyticus either(P=0.936>0.05). All of the cerebrospinal fluid changed more or less. Most of the white cells of the cerebrospinal fluid, glucose, protein were higher than 1 000×10~6/L, 713mg/L and 2 384mg/L respectively.All of the cases were administrated Vancomycin 1.0g twice or three times a day, while the dose was changed to 0.5g when the temperature had been normal for 3 days. The range was 5d to 37d when the drug was stoped at the temperature had been normal for 5-7d and negative culture for 3 times with an average time of 17.0±8.1d, while it's lucky that all were sensitive to Vancomycin. At the same time, all were performed lumbar puncher placing a lumbar anesthesia tube to drain the inflamed cerebrospinal fluid for 5-21d(9d in average). Most of the patients, except 2 died for failure of the respiratory and circulatory systems, were better or cured at last. The mortality was 6.7%(2/30).CONCLUSION1.Intracranial staphylococcic meningitis after craniotomy was increasing, most of which were caused by Staphylococcus epidermidis accompanying Gram-negative bacteria 6-16 days after the operations. 2. Intracranial staphylococcic meningitis, especially caused by Staphylococcus epidermidis, has predilection of the patients with cerebrospinal fluid shunt or external ventrical drainage.3.Though the biochemical changes of cerebrospinal fluid of intracranial staphylococcic meningitis were detected, there was no specificity.4.The increasing resistance to antibiotics of the Staphylococcus makes the cure more and more difficult, while Vancomycin is still a good choice.5.External drainage of the cerebrospinal fluid from the lumber subdural cyst was an effective measure to intracranial staphylococcic meningitis.
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