Etiological analysis, risk model construction of wound infection after craniotomy and predictive nursing

To analyze the features of etiological distribution and risk factors of wound infection after craniotomy, and to observe the intervention effect of predictive nursing.

A total of 412 patients who underwent craniotomy in the Neurosurgery Department of the hospital from January 2020 to December 2021 were selected as research objects. The incidence and influencing factors of postoperative wound infection were analyzed, and the infection risk model was established. Cerebrospinal fluid samples were extracted for bacterial culture and distribution of pathogenic bacteria was recorded. All patients with postoperative wound infection were randomly divided into control group (n=38) and observation group (n=39), receiving routine nursing intervention and predictive nursing mode, respectively. After 2 months of intervention, incidence of adverse reactions were compared between the two groups.

Patients'age, whether to open mastoid air cells in operation or not, whether to perform drainage or not, drainage time, operation time, whether to have implants or not, American Society of Anesthesiologists (ASA) grade, presence or absence of postoperative cerebrospinal fluid leakage had significant influences on postoperative infection (P < 0.05). Logistic analysis showed that operation time≥4 hours, drainage time≥3 days, open mastoid air chamber and postoperative cerebrospinal fluid leakage were risk factors for postoperative infection (P < 0.05). Eighty-nine strains of bacteria were obtained after culture of cerebrospinal fluid samples from patients, among which 34 strains (38.20%) were Gram-positive bacteria, mainly including Staphylococcus epidermidis (44.12%) and Staphylococcus aureus (35.29%); 55 strains (61.80%) were Gram-negative bacteria, mainly including Acinetobacter baumannii (34.55%), Klebsiella pneumoniae (27.27%) and Escherichia coli (20.00%). The incidences of secondary infection, urinary system infection, pneumonia, phlebitis and bedsore in the control group were 13.16%, 18.42%, 15.79%, 15.79%, 18.42%, respectively, while those in the observation group were 5.13%, 2.56%, 2.56%, 0%, 5.13%, respectively.

The incidence of wound infection is high in patients undergoing craniotomy, and these patients are mainly infected by Gram-negative bacteria. It is easy to be affected by drainage events, operation time, cerebrospinal fluid leakage and whether to open the mastoid air chamber or not.