Clinical Features And Risk Factors Of Intracranial Infection In Patients With Traumatic Brain Injury

Objective:The clinical characteristics and risk factors of postoperative intracranial infection in patients with TBI treated in our hospital were analyzed in order to provide reference for guiding clinical empirical medication and effectively preventing the occurrence of intracranial infection in the future.Methods:A total of 186 patients with craniocerebral injury who underwent craniotomy in the emergency department of the First Hospital of Shanxi Medical University from March2017 to March 2019 were collected as research subjects.They were divided into infection group and control group according to whether intracranial infection occurred after surgery.Subjects' age,gender,whether they have diabetes,admission GCS score,severity,cerebrospinal fluid leakage before surgery,admission diagnosis,surgical data,number of lumbar punctures,time of indwelling drainage tube,mechanical ventilation,tracheotomy,intensive care Room length of stay,preoperative hemoglobin,postoperative hypoproteinemia.Univariate analysis and binary logistic analysis were used to analyze the above possible related factors.Results:This analysis showed that the incidence of intracranial infection in TBI patients after craniotomy was 10.2%(190.186),and 8 people died.Univariate analysis showed that there were significant differences in diabetes mellitus,admission GCS score,severity,preoperative cerebrospinal fluid leakage,operation time,reoperation,indwelling drainage tube,ICU hospitalization time,tracheotomy and hypoproteinemia between the infection group and the control group.There was no significant difference in sex,age,emergency operation,intraoperative blood loss,lumbar puncture,mechanical ventilation and preoperative hemoglobin between the two groups(p > 0.05).Binary logistic regression analysis showed that diabetes mellitus(OR=6.442 95%CI 1.202-34.526),reoperation(OR=11.674 95%CI 2.365-57.621),ICU hospitalization(OR=1.259 95%CI0.997-1.539),preoperative cerebrospinal fluid leakage(OR=5.453 95% 1.348-22.053)and hypoproteinemia(OR=3.983 95%CI 1.028-15.433)were the main risk factors of postoperative intracranial infection.The average postoperative diagnosis of intracranial infection was 7.05 days after operation.in the infection group,cerebrospinal fluid was collected for 54 times of rapid culture,of which 29 cases had pathogens,the first three were Staphylococcus aureus,Staphylococcus epidermidis and coagulase negative staphylococci.Conclusion:(1)The incidence of intracranial infection in patients with TBI was 10.2%;the main pathogens were Gram-positive bacteria(94.74%),and the first three were Staphylococcus aureus,Staphylococcus epidermidis and coagulase-negative staphylococci,respectively.According to the distribution characteristics of pathogenic bacteria in hospital and the results of drug sensitivity,the clinical rational use of antibiotics was guided.(2)Diabetes mellitus,admission GCS score,severity,preoperative cerebrospinal fluid leakage,length of operation,reoperation,indwelling drainage tube,ICU hospital stay,tracheotomy and hypoproteinemia were the risk factors of postoperative intracranial infection.(3)Diabetes mellitus,reoperation,ICU hospitalization,preoperative cerebrospinal fluid leakage and hypoproteinemia were the main risk factors of postoperativeintracranial infection.Reoperation had the highest effect on it(OR=11.674).