后颅窝肿瘤术后仅合并颅内感染的临床特点及抗菌药物治疗分析

张福安; 钟东; 石爽; 李炯; 吕东; 黄浩洋; 夏海坚; 唐文渊; 孙晓川

doi:10.16016/j.1000-5404.201608114

您当前的位置：

首页 >

文章列表页 >

后颅窝肿瘤术后仅合并颅内感染的临床特点及抗菌药物治疗分析

临床医学 | 更新时间：2020-08-05

- 后颅窝肿瘤术后仅合并颅内感染的临床特点及抗菌药物治疗分析
- Clinical characteristics and antimicrobial therapy of only intracranial infection in patients after posterior fossa tumor craniotomy: report of 26 cases
- 第三军医大学学报 2017年39卷第2期页码：192-195
- 作者机构：
  
  400016 重庆, 重庆医科大学附属第一医院神经外科
- 作者简介：
  
  钟东, E-mail:zhongdongdp@sina.com Zhong Dong, E-mail:zhongdongdp@sina.com
- 基金信息：
  
  国家临床重点专科建设项目(财社(2011)170号)
- DOI：10.16016/j.1000-5404.201608114
  中图分类号： R512.3;R619.3;R739.41
- 纸质出版日期：2017-1-30，
  
  收稿日期：2016-8-21，
  
  录用日期：2016-11-1
扫描看全文
张福安, 钟东, 石爽, 等. 后颅窝肿瘤术后仅合并颅内感染的临床特点及抗菌药物治疗分析[J]. 第三军医大学学报, 2017,39(2):192-195.

Fu'an Zhang, Dong Zhong, Shuang Shi, et al. Clinical characteristics and antimicrobial therapy of only intracranial infection in patients after posterior fossa tumor craniotomy: report of 26 cases[J]. J Third Mil Med Univ, 2017,39(2):192-195.
张福安, 钟东, 石爽, 等. 后颅窝肿瘤术后仅合并颅内感染的临床特点及抗菌药物治疗分析[J]. 第三军医大学学报, 2017,39(2):192-195. DOI： 10.16016/j.1000-5404.201608114.

Fu'an Zhang, Dong Zhong, Shuang Shi, et al. Clinical characteristics and antimicrobial therapy of only intracranial infection in patients after posterior fossa tumor craniotomy: report of 26 cases[J]. J Third Mil Med Univ, 2017,39(2):192-195. DOI： 10.16016/j.1000-5404.201608114.

摘要

目的

探讨后颅窝肿瘤术后仅合并颅内感染的早期临床特点及抗菌药物治疗效果。

方法

回顾性分析重庆医科大学附属第一医院神经外科2014年3月至2016年3月显微神经外科手术治疗的后颅窝肿瘤患者195例，依据术后仅合并颅内感染的纳入排除标准，分析早期颅内感染的临床特点、脑脊液(cerebrospinal fluid，CSF)检查结果。依据不同时期经验性抗感染治疗药物分成碳青霉烯类组和联合用药组(碳青霉烯类+万古霉素)，比较两组治疗效果。

结果

共计纳入26例，术后发热时间为(6.2±3.7)d，经验性抗感染治疗时间为(7.1±3.4)d，首次腰椎穿刺时间为(7.9±3.5)d，脑脊液有核细胞数高峰期为(10.2±3.3)d，首次和高峰期有核细胞数分别为(665.4±324.6)×10

/L、(1 935.1±1 437.3)×10

/L，后者较首次明显升高(

＜0.05)。CSF培养阳性5例，以G

菌为主

单用碳青霉烯类组治疗时间(16.6±7.7)d，联合用药组治疗时间(15.5±4.8)d，两组差异无统计学意义(

0.05)。

结论

后颅窝肿瘤术后颅内感染早期临床特点无特异性，且CSF培养阳性率低，术后疑似颅内感染需多次CSF检查，尽早经验性使用抗G

菌药物。

Abstract

Objective

To explore the clinical characteristics and antimicrobial therapy of only intracranial infection in patients after posterior fossa tumor craniotomy.

Methods

Clinical data of 195 patients with posterior fossa tumor

who accepted microneurosurgery in the department of neurosurgery of the First Affiliated Hospital of Chongqing Medical University from March 2014 to March 2016

were retrospectively analyzed. According to the inclusion and exclusion standards of intracranial infection

the research objects were selected

and the early clinical characteristics and the examination result of cerebrospinal fluid (CSF) were analyzed. According to different periods

empirical antibiotics were applied

and the patients were divided into 2 groups: carbapenem group and combination group (carbapenem+vancomycin). The treatment effects were compared.

Results

There were 26 cases in accordance with the inclusive criteria. The mean time of fever was 6.2±3.7 d

empirical antibiotic therapy was 7.1±3.4 d

the first time of lumber puncture was 7.9±3.5 d

and the time of the highest leukocyte count in CSF was 10.2±3.3 d. The first leukocyte count and the highest leukocyte count of CSF were (665.4±324.6)×10

/L and (1 935.1±1 437.3) ×10

respectively

and the latter was significantly higher than the former(

＜0.05). There were 5 cases of positive CSF culture

and Gram-negative bacteria were dominant. The treatment time of the carbapenem group was 16.6±7.7 d

while the combination group was 15.5±4.8 d

but the 2 groups had no significant difference (

0.05).

Conclusion

There is no significant clinical characteristics in early intracranial infection after posterior fossa tumor craniotomy

and has lower positive rate of CSF culture. If the patient is suspicious of intracranial infection

the clinician needs to carry out examination of CSF as soon as possible repeatedly. Meanwhile

any suspicious objects should be treated with empirical antibiotics against Gram-negative bacteria immediately.

关键词

后颅窝肿瘤颅内感染临床特点脑脊液抗菌药物治疗

Keywords

posterior fossa tumorintracranial infectionclinical characteristicscerebrospinal fluidantimicrobial therapy

references

Reichert M C, Medeiros E A, Ferraz F A. Hospital-acquired meningitis in patients undergoing craniotomy: incidence, evolution, and risk factors[J]. Am J Infect Control, 2002, 30(3): 158-164.DOI: 10.1067/mic.2002.119925

岳晓艳, 石广志.神经外科术后颅内感染患者的抗生素使用[J].首都医科大学学报, 2013, 34(2): 177-180.DOI: 10.3969/j.issn.1006-7795.2013.02.003

郝淑煜, 李达, 薛湛, 等.硬膜下入路切除颅底肿瘤术后发热相关因素分析[J]. 中国微侵袭神经外科杂志, 2016, 21(1): 1-3.DOI: 10.11850/j.issn.1009-122X.2016.01.001

张翼, 余刚. 降钙素原在颅内感染中的临床应用研究进展[J]. 中国全科医学, 2012, 15(8): 2732-2734.DOI: 10.3969/j.issn.1007-9572.2012.08.082

Kourbeti I S, Vakis A F, Ziakas P, et al. Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis[J].J Neurosurg, 2015, 122(5): 1113-1119. DOI: 10.3171/2014.8.JNS132557

Weisfelt M, van de Beek D, Spanjaard L, et al. Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series[J]. Lancet Neurol, 2006, 5(2): 123-129. DOI: 10.1016/S1474-4422(05)70288-X

Chiang H Y, Kamath A S, Pottinger J M, et al. Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy[J]. J Neurosurg, 2014, 120(2): 509-521.DOI: 10.3171/2013.9.JNS13843

崔向丽, 林松, 隋大立, 等. 神经外科术后颅内感染的诊疗进展[J]. 中华神经外科杂志, 2014, 30(3): 312-314. DOI: 10.3760/cma.j.issn.1001-2346.2014.03.030

Chidambaram S, Nair M N, Krishnan S S, et al. Postoperative Central Nervous System Infection After Neurosurgery in a Modernized, Resource-Limited Tertiary Neurosurgical Center in South Asia[J].World Neurosurg, 2015, 84 (6): 1668-1673.DOI: 10.1016/j.wneu.2015.07.006

Kanegaye J T, Soliemanzadeh P, Bradley J S. Lumbar puncture in pediatric bacterial meningitis: defining the time interval for recovery of cerebrospinal fluid pathogens after parenteral antibiotic pretreatment[J]. Pediatrics, 2001, 108(5): 1169-1174.

Tan Y C, Gill A K, Kim K S. Treatment strategies for central nervous system infections: an update[J].Expert Opin Pharmacother, 2015, 16(2): 187-203. DOI: 10.1517/14656566.2015.973851

Bratzler D W, Dellinger E P, Olsen K M, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery[J]. Surg Infect (Larchmt), 2013, 14(1): 73-156. DOI: 10.1089/sur.2013.9999

Huang C R, Chen S F, Lu C H, et al. Clinical characteristics and therapeutic outcomes of nosocomial super-infection in adult bacterial meningitis[J]. BMC Infect Dis, 2011, 11: 133. DOI: 10.1186/1471-2334-11-133

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

早期腰大池持续脑脊液外引流术在儿童后颅窝肿瘤切除术中的应用