1起内镜下三叉神经微血管减压术后颅内感染事件的调查与处置

Investigation and management of an intracranial infection event after endoscopic microvascular decompression for treatment of trigeminal neuralgia

    摘要
  • 摘要:
    目的 调查某教学医院经内镜下三叉神经微血管减压术发生颅内感染的原因。
    方法 对青岛大学附属医院2024年7月神经外科发生2例经内镜下三叉神经微血管减压术后颅内感染患者(F和Z)进行流行病学调查, 并对手术涉及的人员、环境和材料进行细菌学采样和培养。采用脉冲场凝胶电泳(PFGE)和二代测序分析患者和环境菌株的同源性。
    结果 在患者备皮使用的3个电动剃须刀中分离出霍氏肠杆菌和肺炎克雷伯菌；从F患者脑脊液中分离到霍氏肠杆菌(E1株)和肺炎克雷伯菌(K1~K4株), Z患者脑脊液和切口分泌物分离到霍氏肠杆菌(E2和E3株)。PFGE显示：分离自患者的霍氏肠杆菌(E1~E3株)与从电动剃须刀分离的霍氏肠杆菌(B2-E~B4-E株)具有同源性, 且这些菌携带blaACT-15和blaCTX-M-3基因和属于ST50型；分离自患者的肺炎克雷伯菌(K1~K4株)与从电动剃须刀分离的肺炎克雷伯菌(B2-K~B4-K株)也具有同源性, 且这些菌携带blaSHV-164和blaTEM-1A基因和属于ST8型。
    结论 经内镜下三叉神经微血管减压术后颅内感染与备皮使用被霍氏肠杆菌和肺炎克雷伯菌污染的电动剃须刀有关。因此, 有必要对用于备皮的电动剃须刀进行消毒和消毒效果的监测。

     

    Abstract:
    OBJECTIVE To investigate the causes of intracranial infection after endoscopic microvascular decompression for the treatment of trigeminal neuralgia in a teaching hospital.
    METHODS An epidemiological survey was conducted on 2 patients (F and Z) who developed intracranial infections after microvascular decompression for trigeminal neuralgia in the department of neurosurgery of the Affiliated Hospital of Qingdao University in July 2024. Bacteriological sampling and culture were carried out for the staff, environment and materials involved in the surgery. The homology of strains between the strains recovered from the patients and those from the environmental was analyzed by means of pulsed-field gel electrophoresis (PFGE) and second-generation illumina sequencing.
    RESULTS All the three electric razors that were used for preoperative shaving of the patients were found to be contaminated with Enterobacter hormaechei and Klebsiella pneumoniae. Enterobacter hormaechei strain (E1) and K. pneumoniae strains (K1 to K4) were isolated from the cerebrospinal fluid of patient F. Enterobacter hormaechei strains (E2 and E3) were isolated from the cerebrospinal fluid and wound secretion of patient Z. PFGE analysis showed that the E. hormaechei strains (E1, E2 and E3) isolated from the patients were homologous to the strains of E. hormaechei isolated from the electric shavers (B2-E, B3-E and B4-E), and all these strains were of ST50 type and carried blaACT-15 and blaCTX-M-3 genes, and that the K.pneumoniae strains (K1-K4) were also homologous to the K. pneumoniae strains isolated from the electric shavers (B2-K, B3-K and B4-K), and all these strains were of ST8 type and carried blaSHV-164 and blaTEM-1A genes.
    CONCLUSIONS The intracranial infections that occur after endoscopic microvascular decompression for the treatment of trigeminal neuralgia are related to the preoperative use of electric shavers contaminated with E. hormaechei and K. pneumonia during skin preparation. Therefore, it is necessary to carry out the disinfection of electric shavers that are used for skin preparation and monitor the disinfection effect.

     

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