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中华实验和临床感染病杂志(电子版) ›› 2017, Vol. 11 ›› Issue (06) : 582 -586. doi: 10.3877/cma.j.issn.1674-1358.2017.06.012

临床论著

慢性脑膜炎脑脊液引流继发感染的相关危险因素
黄莺1, 张炜2, 杨清銮2, 张冰琰2, 邵凌云2, 张文宏2,()   
  1. 1. 200040 上海,复旦大学附属华山医院护理部
    2. 200040 上海,复旦大学附属华山医院感染科
  • 收稿日期:2017-02-04 出版日期:2017-12-15
  • 通信作者: 张文宏

Risk factors for secondary infection in patients with chronic meningitis who underwent cerebrospinal fluid drainage

Ying Huang1, Wei Zhang2, Qingluan Yang2, Bingyan Zhang2, Lingyun Shao2, Wenhong Zhang2,()   

  1. 1. Department of Nursing, Huashan Hospital, Fudan University, Shanghai 200040, China
    2. Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
  • Received:2017-02-04 Published:2017-12-15
  • Corresponding author: Wenhong Zhang
引用本文:

黄莺, 张炜, 杨清銮, 张冰琰, 邵凌云, 张文宏. 慢性脑膜炎脑脊液引流继发感染的相关危险因素[J/OL]. 中华实验和临床感染病杂志(电子版), 2017, 11(06): 582-586.

Ying Huang, Wei Zhang, Qingluan Yang, Bingyan Zhang, Lingyun Shao, Wenhong Zhang. Risk factors for secondary infection in patients with chronic meningitis who underwent cerebrospinal fluid drainage[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2017, 11(06): 582-586.

目的

探讨慢性脑膜炎患者行脑脊液引流继发感染的发生率和常见病原菌及危险因素。

方法

连续收集复旦大学附属华山医院感染科2011年6月至2016年10月结核性/真菌性脑膜炎患者的临床资料。连续变量采用Mann-Whitney检验,分类变量采用fisher精确检验。

结果

2011年6月至2016年10月因结核性/真菌性脑膜炎住院的患者共463例,其中29例患者行脑脊液引流(包括脑室外引流和腰大池引流),其中有6例患者因病情需要先后行脑室外引流和腰大池引流,共35例次行脑脊液引流。9例次(25.7%)患者发生继发感染。所有患者均行脑脊液培养,8例次(88.9%)细菌培养阳性,其中表皮葡萄球菌3株,肺炎克雷伯菌3株,鲍曼不动杆菌2株,耐甲氧西林金黄色葡萄球菌1株(有1例患者先后培养出肺炎克雷伯菌和鲍曼不动杆菌)。脑室外引流继发感染者的引流时间较未感染者长,中位数分别为77 d和24 d,但差异无统计学意义。而进一步分析发现,脑室外引流的Ommaya囊穿刺次数为继发感染发生的危险因素(U = 12.0、P = 0.0059)。

结论

慢性脑膜炎脑脊液引流后继发感染是其并发症之一,病原菌中革兰阳性球菌与革兰阴性杆菌比例相当。增加脑室外引流的Ommaya囊穿刺次数会提高脑脊液引流后继发感染的风险。

Objective

To investigate the incidence, etiology and risk factors in patients with chronic meningitis who underwent cerebrospinal fluid drainage.

Methods

Clinical data of patients diagnosed with tubercular meningitis and fungal meningitis in Huashan Hospital, Fudan University from June 2011 to October 2016 were collected. The continuous data were compared by Mann-Whitney test. The categorical variables were analyzed by Fisher’s exact test.

Results

Total of 29 patients with cerebrospinal fluid drainage (including external ventricular drainage and lumbar drainage) were enrolled, among whom, 6 patients underwent more than once drainage, thus a total of 35 cases were enrolled. Nine cases (25.7%) with secondary infection were identified. All the 9 CSF samples were collected for bacterial culture, 8 were positive with 3 of Staphylococcus epidermidis, 3 of Klebsiella pneumoniae, 2 of Acinetobacter baumannii, one of methicillin-resistant Staphylococcus aureus (MRSA) (Klebsiella pneumoniae and Acinetobacter baumannii were cultured in one patient successively). In the group of external ventricular drainage, patients who developed secondary infection were drained longer than those without secondary infection. The median time of patients in the two groups were 77 days and 24 days, respectively, with no significant difference. Further analysis showed that it was more likely to develop secondary infection for patients underwent external ventricular drainage whose Ommaya reservoirs were punctured more times compared with those without secondary infection, with significant difference (U = 12.0, P = 0.0059).

Conclusions

Secondary infection remained a common complication of cerebrospinal fluid drainage, and were comparatively induced by Gram positive cocci and Gram negative bacilli. More frequent puncture of Ommaya reservoir could increase the incidence of secondary infection.

表1 脑脊液引流继发感染者与未继发感染者的临床特征
指标 例次(n = 35) 继发感染组(n = 9) 未继发感染组(n = 26) U P
临床表现[例(%)]          
  意识障碍 24(68.6) 6(66.6) 18(69.2) 1.000
  抽搐 11(31.4) 3(33.3) 8(30.8) 1.000
病史[例(%)]          
  脑脊液引流史 4(11.4) 3(33.3) 1(3.8) 0.0441
  脑部手术史 5(14.3) 2(22.2) 3(11.5) 0.5855
置管时长(d)a 24(10,61) 24(9.5,112.5) 24(9.75,47.5) 105.5 0.6763
住院时间(d)a 57(30,97) 45.5(30,79) 60.0(24,111.5) 105.0 0.6628
病死率(%) 8.6 22.2 3.8 0.1558
诊断[例(%)]          
  真菌性脑膜炎 24(68.6) 7(77.7) 17(65.4) 0.6855
  结核性脑膜炎 11(31.4) 2(22.2) 9(34.6) 0.6855
脑脊液引流前血常规a          
  白细胞(× 109/L) 7.89(6.33,11.18) 7.59(5.63,7.96) 8.56(6.41,11.30) 81.0 0.1778
  中性粒细胞(%) 74.8(66.7,85.8) 69.7(65.8,72.2) 76.7(67.0,87.2) 67.0 0.0590
脑脊液引流前脑脊液a          
  白细胞(× 106/L) 15.0(1.0,125.0) 5.0(1.5,192.0) 22.5(1.0,139.3) 113.5 0.9029
  多核细胞(%) 25.4(17.7,61.5) 21.5(19.0,24.0) 34.0(17.0,68.5) 12.0 0.6405
  糖(mmol/L) 2.40(1.40,3.60) 1.55(2.40,3.40) 2.35(1.10,3.90) 114.5 0.9333
  氯(mmol/L) 114.0(107.0,120.0) 117.0(111.0,123.0) 112.5(106.5,120.0) 80.0 0.1677
  蛋白(mg/L) 1 348.0(485.0,15 000.0) 1 197.0(348.5,2 105.0) 1 364.0(577.3,2 935.0) 91.5 0.3459
表2 腰大池引流继发感染者与未继发感染者各指标水平
表3 脑室外引流继发感染者与未继发感染者各指标水平
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