Analysis Of The Isolation,Risk Factors And Treatment Of Postoperative Intracranial Infection With Acinetobacter Baumannii

Objective: To investigate the pathogenic spectrum and antimicrobial sensitivity of central nervous system infection after craniotomy in the first hospital of China medical university,and to analyze the risk factors of intracranial infection with acinetobacter baumannii,so as to provide scientific evidences for clinical prevention and treatment.Methods:To investigate the drug resistance and pathogens of cerebrospinal fluid pathogens in 139 patients with central nervous system infection after craniotomy in neurosurgery department of the first hospital of China medical university from January 2011 to March 2018.SPSS 20.0 statistical software was used to analyze the difference in risk factors of intracranial infection between acinetobacter baumannii and other bacterial groups.The treatment of acinetobacter baumannii infection was analyzed.Results: 1.A total of 139 patients were collected according to th inclusion criteria,166 strains of pathogenic bacteria were isolated from cerebrospinal fluid,including 57.2%(95/166)gram-negative bacteria and 42.8%(71/166)gram-positive bacteria.The most frequently isolated pathogen was Acinetobacter baumannii(A baumannii in)28.31%,followed by coagulase negative staphylococcus 20.48%(34/166).2.Carbapenems resistant A baumannii in 40 of 47 strains of A baumannii.Among the 34 strains of coagulase negative staphylococcus,32 were methicillin-resistant staphylococcus,and no vancomycin and linezolid resistant strains were found.3.Monofactor analysis showed that Glasgow Coma Scale score < 12,ASA physical status classification ystem? IV,emergency procedure,pneumonia,ICU admission,invasive ventilation,indwelling urethral catheter ?6d,gastric intubation ?10d,and cerebrospinal fluid leakage were risk factors for intracranial infection of acinetobacter baumannii after craniotomy.Factors with statistical significance in monofactor analysis were included in Logistic multivariate regression analysis.Cerebrospinal fluid leakage(OR=3.19,95%CI :1.18-5.59)and Glasgow Coma Scale score ?8(OR=3.64,95%CI:1.02-12.99)was an independent risk factor for intracranial infection of A baumannii after major craniotomy.4.The primary diseases of 47 patients with intracranial infection of acinetobacter baumannii were mainly cerebral hemorrhage(21/47),intracranial tumors(13/47)and traumatic brain injury(11/47),the mortality was 23.4%,the unfavourable prognosis was 46.8%,the healing rate was 17%,and the improvement rate was 12.8%.Three patients died within 48 hours after the etiological report,respectively complicated with peritoneal,pulmonary and bloodstream infection by A baumannii.Thirteen patients gave up treatment within 72 h,and 31 patients continued treatment,including 9 cases treated with meropenem monotherapy,9 cases treated with two or three drugs based on tegacycline,4 cases treated with minocycline combined with cefoperazone/sulbactam,and 1 case each given with gentamicin and tegacycline combined with polymyxin intrathecal administration.Conclusion: 1.Acinetobacter baumannii has become the main pathogen of central nervous system infection after neurosurgery,mainly carbapene-resistant strains,and its distribution in the environment and human colonization are closely related to infection.Cerebrospinal fluid leakage and GCS score 8 increase the risk of intracranial infection of acinetobacter baumannii.2.The treatment of Acinetobacter baumannii intracranial infection is based on in vitro susceptibility results,with meropenem,cefoperazone/sulbactam and minocycline as the main drugs,while polymyxin B was rarely used.Some case of MDRAB infection combined with tegacycline were reported.