Clinical Characteristics And Risk Factors Of Postoperative Infection In The Department Of Neurosurgery Before And After Intervention Of A 3A Hospital

Object:In order to investigate the influence of rational use of antimicrobial drugs in neurosurgical postoperative infection and bacterial resistance, clinical pharmacist intervention and remediation activities to promote rational use of antibiotics, guide clinicians to carry out a reasonable anti-infection treatment, fully rational use of medical resources treating infections, it also provides a theoretical basis to increase clinical pharmacist interventions and developing rational drug policies.Methods : All postoperative patients` records in two different time periods of a top three hospital were investigated. These two periods were June 2009-June 2010(before intervention) and June2012-June 2013(after intervention). Survey projects included hospital number, date of admission, discharge time, age, sex, weight, length of stay, hospitalization season, blood type, diagnosis, chronic underlying diseases, lesions, invasive operation, unconsciousness,immunity, swallowing reflex, drug allergies, smoking history, drinking history, surgery name, duration of surgery, type of incision, whether the implantation of artificial materials,pathological findings, whether placed drainage tubes, blood transfusion, whether stay NICU, hormones utilization,H2- receptor blockers utilization, proton pump inhibitors,antimicrobial agents preventive, antimicrobial drug combination, the dosage of antibiotics,days of antibacterials use, and hospital infection time, the site of infection, pathogens and antimicrobial susceptibility results and thesituation of drug utilization. The survey content,neurosurgery postoperative infection, infection-related factors, pathogen drug resistance before and after the intervention were analyzed.Results: Before intervention group contained 667 neurosurgical records,48 cases of patients with postoperative infection, the infection rate was 7.20%;there were 1463 cases of neurosurgical surgery medical records in after intervention group, 78 cases of patients with hospital infection, the infection rate was 5.33%.After the intervention,the postoperative infection rate has declined, the difference between both groups was statistically significant(P <0.05). The neurosurgical operation infection siteswere mainly the lower respiratory tract and the brain, accounting for more than 80% of all postoperative infections. 263 pathogens were detected in before intervention group, including G- bacilli 168(63.88%), G+ cocci 58(22.05%); 173pathogens were detected in after intervention group, including G- bacilli 130(75.14 %),G+ cocci 41(23.70%). The number of main pathogens decined and the sensitivity of main antibacterial drug incresed, Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus. After the intervention, the consumptions and costs of enzyme inhibitors, penicillins have increased, the consumptions and costs of other antimicrobial drugs has fallen, the cost of cephalosporins declinedby 65.48%, the cost of carbapenemsdeclined by 68.01%, the cost amplitude was gradually reduced. From the cost point of view, the total cost of antibiotics reduced by 28.92%.Logistic regression analysis was implemented, risk factors for infection before intervention group included the number of days after the medication, swallowing reflex, combination of antibiotics,proton pump inhibitors; risk factors for infection after intervention group included length of hospital stay, days of administration after surgery, unconsciousness, combination of antibiotics.Before intervention group, the risk factors were sorted by standardized regression coefficients Beta value, the order for risk factors were medication more than 14 days, swallowing emission weakened or disappeared, combination of antibiotics,swallowing reflex examination uncooperative, proton pump inhibitors.After intervention group,the risk factors were sorted by standardized regression coefficients Beta value, the order for risk factors were hospitalization time more than 28 days, medication more than14 days, medication between7 ~ 14 days, combination of antibiotics,disturbance of consciousness, hospitalization time between 14~28days. After the intervention, the risk factors have changed, after the intervention using proton pump inhibitors was no longer a risk factor. Proton pump inhibitors has been more rational use after intervention, the influence degree of combined use antibiotics has decreased.Conclusion:1 After the intervention, the neurosurgical patient hospital postoperative infection rates declined. 2the number of main pathogenic bacteria decreased and the sensitivity to antibiotics was increased;the number and types of antimicrobial agents were decreased, and the use of the one or two generation cephalosporin was significantly increased.3 before and after the intervention, the risk factors of hospital infection have changed, the decrease of influence degree and postoperative infection rate may be related to the rational use of antibiotics.