ABSTRACT
OBJECTIVE:To explore the distribution and drug resistance of pathogens in patients with hospital-acquired pneumo-nia(HAP)from neurosurgery department of the First Affiliated Hospital of Xinjiang Medical University(called“our hospital”for short),so as to provide reference for clinical use of antibiotics in the clinic. METHODS:The pathogen culture and drug sensitivity test of 652 HAP patients were analyzed retrospectively in neurosurgery department of our hospital during May 2011 to May 2015. RESULTS:Of 652 cases,pathogens were detected in 608 cases,with positive rate of 93.3%. Among 608 strains of pathogen, there were 443 strains of Gram-negative bacteria(71.2%)as Klebsiella pneumonia,Pseudomonas aeruginosa and Escherichia co-li;108 strains of Gram-positive bacteria (17.8%) as Staphylococcus aureus and Streptococcus pneumoniae;67 strains of fungus (11.0%)as Candida albicans. There were 67 strains of ESBLs K. pneumonia,43 strains of ESBLs E. coli and 8 strains of methicil-lin-resistant coagulase negative Staphylococci. The drugs sensitive to Gram-negative bacteria included imipenem,piperacillin sodi-um and tazobactam sodium,cefepime,etc.;those sensitive to Gram-positive bacteria included vancomycin,etc. CONCLUSIONS:Main pathogen of HAP patients in neurosurgery department of our hospital are Gram-negative bacteria,and they were highly resis-tant to antibiotics;the highly sensitive drugs to HAP include imipenem and vancomycin,etc.;the antibiotics should be used ratio-nally according to etiological analysis.
ABSTRACT
Objective To investigate the pathogenic bacteria types and distribution characteristics of critical patients with lower respiratory tract infection in neurosurgery department,and to analyze the high risk fac?tors of lower respiratory tract infections. Methods A retrospective analysis of 80 cases of critical patients with lower respiratory tract infection in neurosurgery department of General Hospital of People Liberation Army from April 2013 to April 2014 was carried out. The pathogenic bacteria types and distribution characteristics of lower respiratory tract infection were analyzed by means of bacterial identification,and single factor and multi factor Lo?gistic regression analysis was carried out to analyze the related factors of lower respiratory tract infection.Results One hundred and thirty?four strains of pathogenic bacteria were cultured from sputum of 80 cases of patients. Among which the gram negative bacteria were 109 strains,accounting for 81.34%(109/134),while the Gram positive bacteria were 17 strains,accounting for 12.69%(17/134) and the fungi were 2 strains,accounting for 1.49%(2/134).The proportion of three kinds of pathogenic bacteria had statistical significance(P=0.004, 0.001). The single factor Logistic regression analysis showed that,younger age,use of ventilator,use of antimi?crobial drugs and pulmonary infection rate were protective factors of lung infection(OR(95%CI)=0.586(0.475-0.722),0.708(0.574-0.873),0.827(0.697-0.981);P=0.043,0.007,0.000);disturbance of consciousness, tracheotomy,insert gastric tube, surgery and pulmonary infection incidence were risk factors for lung infection (OR(95%CI)=4.769(1.069-21.276),11.612(5.438-24.792),22.989(19.385-27.263),10.426(8.789-12.361);P=0.001,0.008,0.005,0.002).The multi factor Logistic regression analysis showed that there was a significant correlation between the trachea incision, the consciousness and the lower respiratory tract infection (OR(95%CI)=4.627(2.143-20.645),10.412(2.334-46.455);P=0.009,0.002).Conclusion Patients with conscious disturbance and tracheotomy were more likely to have lower respiratory tract infections. The pathogens of lower respiratory tract infections are Gram?negative bacteria,and the majority of pathogens are high resistance, and it is multi drug resistance.
ABSTRACT
Objective To investigate the specimen source and drug resistance in the strains of Acinetobacter baumannii isolated from the submitted samples in the neurosurgery wards of our hospital during 2011-2014 in order to provide the reference for clini‐cal treatment and nosocomial infection control .Methods A retrospective analysis was performed on the clinical data of clinical dis‐tribution and antibacterial drugs sensitivity in 404 non‐repeated strains of Acinetobacter baumannii isolated from the samples of neurosurgical patients .Results The mainly specimen source of Acinetobacter baumannii isolated from neurosurgical patients was sputum and cerebrospinal fluid ,accounting for 89 .1% and 7 .9% respectively .Acinetobacter baumannii isolates showed the lowest resistance rates to minocycline and cefoperazone/sulbactam (28 .6% and 31 .8% respectively) .The resistance rates to imipenem and meropenem were 79 .4% and 83 .2% respectively ;the resistance rate to other antibacterial drugs exceeded 69 .0% .Conclusion Acinetobacter baumanii strains isolated from the neurosurgery department have higher resistance rates to many kinds of antibacteri‐al agents ,minocycline and cefoperazone/sulbactam still has good in vitro antibacterial activity against Acinetobacter baumanii .Clinic should strengthen the management of antibacterial agents ,increases the rate of drug susceptibility test and rationally uses the anti‐bacterial drugs .
ABSTRACT
Objective:To investigate the application of Xingnaojing injection ( XNJI) in the patients of neurosurgery department to provide reference for the rational drug use. Methods:The retrospective investigation was applied to survey 200 hospitalization records with XNJI from a certain hospital between January 2014 and June 2015. The usage, dosage, medication purpose, course of treatment, compatibility and adverse effects of XNJI were analyzed. Results:The unlabeled use of XNJI was found in neurosurgery department, and 34. 50% of the surveyed patients were found that their diagnoses didn’t conform to the indications in the medicine specification of XNJI. Moreover, 92. 50% of the inpatients were treated with overdose and almost 90. 00% were treated with single drug dose of 40 ml. It was also found that XNJI was often combined with potassium chloride or with potassium chloride plus insulin in clinical use. Conclu-sion:There is some irrational use of XNJI in clinics, thus the use and management of traditional Chinese medicine injections should be strengthened and regulated.
ABSTRACT
OBJECTIVE:To investigate the role of clinical pharmacists in the drug treatment of infected patients in neurosur-gery department. METHODS:Clinical pharmacists participated in the formulation of anti-infective treatment plan for a infected case after meningioma surgery. According to drug antibacterial spectrum,result of laboratory and image examinations and disease condition of patients,etc.,the patient was given cefoperazone sodium and sulbactam sodium (3 g,ivgtt,q8 h),rifampicin (0.45 g,ivgtt,q12 h)and vancomycin(1 g,ivgtt,q12 h);the body temperature of the patient increased again and clinical pharmacist suggested meropenem 1 g,ivgtt,q8 h and vancomycin 1 g,ivgtt,q12 h. RESULTS:After 53 d treatment,infection was timely brought under control. The patient was discharged from hospital after improved on 72th day. CONCLUSIONS:Through the partici-pation of clinical pharmacists in pharmaceutical care for anti-infective drug treatment in neurosurgery department contribute to ratio-nal drug use in the clinic and guarantee the safety of drug use.
ABSTRACT
Objective To assess clinical efficacy and safety of linezolid in treating postoperative intracranial infec-tion after neurosurgery operation,and provide clinical basis for the treatment of postoperative intracranial infection. Methods From January 2011 to December 2012,clinical data of 51 neurosurgery patients receiving linezolid for trea-ting postoperative intracranial infection were collected,changes in symptoms,temperature,cerebrospinal fluid (CSF)bacterial culture,as well as white blood cell (WBC)count,protein and glucose in CSF before and after therapy were compared,clinical efficacy and safety of linezolid in the treatment of postoperative intracranial infection were assessed based on the diagnostic criteria for intracranial infection.Results After linezolid treatment,30 cases of postoperative intracranial infection were cured,and linezolid was effective in 1 2 cases,improved in 5 cases,and ineffective in 4 cases,total effective rate was 92.16%.Of 47 cases with effective therapy,the mean therapy day were 12.5 d (2-27 d),11 of whom isolated gram-positive bacteria from CSF before therapy,and CSF culture were all negative after linezolid therapy.Conclusion Linezolid is effective for treating intracranial infection caused by Staphylococci,Enterococci and other gram-positive bacteria which failed to response to vancomycin therapy.
ABSTRACT
Objective To investigate the possible causes of surgical site infection(SSI)in neurosurgical patients in a hospital during a short period of time.Methods Medical data of 135 neurosurgical operative patients from February 1 to March 15,2013 were reviewed,the possible risk factors for SSI were analyzed retrospectively with case-control study.Results Of 135 operative neurosurgical patients,5 (3.70%)developed SSI.Case-control study showed that the ratio of the run of the fifth operating room and undergoing of secondary operation was 4.07 (95%CI :0.52 -36.65)and 18.00(95%CI :2.00 -180.00)respectively.The difference between each surgeon special SSI rate and the average SSI rate in 2012 (2.54%[17/669])was not significantly different (P >0.05).Bacterial detection of en-vironmental specimens of the fifth operating room showed that except anesthetic cuff exceeded standard,the others were met the national requirements,and the isolated bacteria from anesthetic cuff was coagulase negative Staphylo-coccus ,which was not related with pathogens in infection.Conclusion “The secondary surgery”is the key risk fac-tor for SSI of neurosurgical patients.
ABSTRACT
Objective To investigate risk factors for healthcare-associated infection(HAI)in patients with craniocerebral operation,and provide reference for the prevention and control of HAI.Methods A total of 4 246 cases of craniocerebral surgery in a neurosurgery department from January 2010 to December 2012 were enrolled in the study,the risk fac-tors for HAI were analyzed.Results Of 4 246 cases of craniocerebral surgery,393 patients developed 446 times of post-operative HAI,HAI incidence rate was 9.26%,case infection rate was 10.50%,which were higher than inci-dence (2.02%)and case infection rate (3.02%)of HAI of all hospital during the same period,the difference was statistically significant (χ2 =811 .06,629.30,respectively,P 7 d,antimicrobial use >7 d,central venous and urinary tract cathe-terization,invasive ventilator were risk factors for HAI in patients with craniocerebral operation.Conclusion The incidence of HAI in patients with craniocerebral operation is high,effective preventive and control measures accord-ing to risk factors should be strengthened to reduce the incidence of HAI.
ABSTRACT
Cultivation of scientific research ability for postgraduates in neurosurgery department find expression in morality education, scientific spirit culture, scientific research objective propagan-da, review writing, data analysis and thesis writing, etc. Cultivation of scientific research ability and cultivation of clinical skill supplement each other and both can improve the research ability of post-graduates in neurosurgery department.
ABSTRACT
Objective To explore clinical nursing pathway(CNP) teaching method for nursing practice students.Methods Nursing practice students ( n =120 ) were randomly divided into two groups:experimental group and control group.CNP teaching method was applied in experimental group while traditional teaching method was used in control group.The test results of theory,operational skill,comprehensive quality,patient's satisfaction degree and nursing mistake between the two groups were compared.Results The results of theory,operational skill,comprehensive quality,patient's satisfaction degree in experimental group were obviously better than those in control group(P ＜0.05),the result of nursing mistake in experimental group was greatly decreased compared with that in control group(P ＜ 0.05).Conclusion CNP teaching method is superior to traditional teaching method and it greatly improve the teaching quality.
ABSTRACT
OBJECTIVE To investigate the prevelance of hospital infections of sugical patients in neurosurgery department and analyze the risk factors. METHODS Retrospective survey was made for 456 operative inpatients in neurosurgery department from Jan 2007 to Dec 2008. RESULTS Among them there were totally 66 cases of hospital infections (14.3%). 82 case-times of hospital infections (17.98%)were found. The infections were found located mostly in respiratary tract infection (51.51%) and gastro-intestinal tract infection (16.66%). CONCLUSIONS Surgical patients in neurosurgery department are high-risk group of hospital infection. Normalizing nursing adminstration and strengthening monitoring are effective methods to prevent nosomial infections.