| Objective:1.To analyze the risk factors of postoperative intracranial infection with carbapenem resistant Acinetobacter baumannii(CRAB)in neurosurgical patients from the First Affiliated Hospital of Nanchang University;2.To investigate the clinical efficacy and safety of tigecycline combined with cefoperazone sodium/sulbactam sodium intravenous drip Administration for the treatment of postoperative CRAB intracranial infection in neurosurgical patients.Methods:1.82 patients with intracranial infection with Acinetobacter baumannii after neurosurgery in the First Affiliated Hospital of Nanchang University from January2014 to June 2019 were collected,and the patients were divided into a carbapenem resistant Acinetobacter baumannii group and a carbapenem susceptible Acinetobacter baumannii(CSAB)group based on the susceptibility results using a case-control method.Of these,56 were assigned to the CRAB group and 26 to the CSAB group.The clinical data of the patients were collected and their risk factors were retrospectively analyzed.2.Patients with postoperative intracranial infection CRAB from January 2014 to June 2019 at the Department of Neurosurgery,the First Affiliated Hospital of Nanchang University,and treated with tigecycline combined with cefoperazone sodium/sulbactam sodium by intravenous drip administration were retrospectively reviewed.To evaluate the clinical efficacy and safety of tigecycline combined with cefoperazone sodium/sulbactam sodium intravenous drip for the treatment of intracranial infection in CRAB.Results:1.Univariate analysis showed that age ≥ 60 years old,combined with pulmonary infection,cerebrospinal fluid leakage,number of operations ≥ 2 times,hospitalization in NICU,tracheotomy,postoperative use of hormone,postoperative hypoproteinemia,and use of carbapenem antibiotics before infection were risk factors for postoperative intracranial CRAB in neurosurgical patients(P < 0.05).2.Multivariate analysis showed that postoperative hormone use and hypoproteinemia were independent risk factors for CRAB in neurosurgical patients(P< 0.05).The probability of CRAB infection in patients with postoperative hormone use was 5.356 times that in patients without hormone use,and the probability of CRAB infection in patients with postoperative hypoproteinemia was 4.287 times that in patients without postoperative hypoproteinemia.3.After 16-62 days(mean 37.8 days)of anti infective treatment with tigecycline combined with cefoperazone sodium/sulbactam sodium by intravenous point infusion,most patients’ clinical symptoms and signs were significantly improved compared with before treatment.Of these,5 recovered,1 responded,and 3 were abandoned or died,giving a CSF bacterial clearance rate of 77.8% and a clinical overall response rate of 66.7%.4.The incidence of adverse reactions during anti infection treatment was only11.1%.Conclusion:1.Univariate analysis found that age ≥ 60 years old,combined with pulmonary infection,cerebrospinal fluid leakage,number of operations ≥ 2 times,hospitalization in NICU,tracheotomy,postoperative use of hormone,postoperative hypoproteinemia,and use of carbapenem antibiotics before infection were risk factors for postoperative intracranial infection of CRAB in neurosurgical patients.2.Multivariate analysis found that postoperative hormone use and hypoproteinemia were independent risk factors for CRAB in neurosurgical patients.3.Take targeted measures on risk factors for postoperative intracranial infection CRAB to prevent and control the occurrence of postoperative intracranial infection CRAB in neurosurgical patients.4.Early and long-term application of tigecycline combined with cefoperazone sodium/sulbactam sodium intravenous drip administration can effectively treat postoperative CRAB intracranial infection in neurosurgical patients with good safety. |
