临床药师参与会诊脊柱手术部位早期感染患者的回顾性分析

Retrospective analysis of clinical pharmacists participating in the consultation of patients with early infection at spinal surgical sites

目的分析脊柱手术部位早期感染的病例特点,为临床药师参与脊柱手术部位感染治疗提供依据。方法回顾性分析2018年1月至2020年9月临床药师参与会诊的脊柱手术部位早期感染患者的临床特点、实验室指标、抗菌药物治疗方案及疗效。结果16例患者纳入分析,中位年龄66岁,81.25%为腰椎手术,最常见的基础疾病是糖尿病。脊柱手术部位早期感染主要的临床特征为体温升高和伤口局部压痛。实验室指标提示所有患者会诊前C反应蛋白(CRP)和/或红细胞沉降率(ESR)升高,13例患者CRP>30.4mg·L^(-1),7例患者WBC升高;病原菌检出率为43.7%,分别为表皮葡萄球菌5例和金黄色葡萄球菌2例,其中3例表皮葡萄球菌对左氧氟沙星耐药。会诊后11例患者经验性使用万古霉素,静脉抗菌药物使用时间均数为12 d。会诊前(术后≥4 d)CRP中位数为78.0 mg·L^(-1),会诊后CRP中位数为26.5 mg·L^(-1),会诊前后差异有统计学意义。结论术后≥4 d时CRP>30.4 mg·L^(-1)是预测脊柱术后手术部位早期感染较敏感的标记物,持续地评估ESR和CRP的联合趋势是至关重要的。最主要致病菌为革兰阳性菌,不推荐单独使用左氧氟沙星。

AIM To analyze tthe characteristics of early infection at spinal surgery sites,so as to provide evidence for clinical pharmacists to participate in the treatment of spinal surgery site infection.METHODS The patients with early infection at spinal surgical site who were consulted by pharmacists during the period from January 2018 to September 2020 were retrospectively analyzed,and the clinical characteristics,laboratory indexes,antimicrobial regimen and treatment results of patients were compared.RESULTS A total of 16 patients were included in the study,with median age of 66 years old.The 81.25%of them were operated on lumbar vertebrae,and the most common basic disease was diabetes mellitus.The most prominent clinical features of early infection at spinal surgical sites were increased body temperature and local tenderness in the wound.Before consultation(postoperative≥4 d),CRP>30.4 mg·L^(-1)in 13 patients,7 patients had elevated WBC.The detection rate of pathogenic bacteria was 43.7%,including 5 cases of Staphylococcus epidermidis and 2 cases of Staphylococcus aureus,among which 3 cases of Staphylococcus epidermidis resistant to levofloxacin.After consultation,11 patients received empirical vancomycin,and the mean time of intravenous antimicrobial drugs was 12 d.The median CRP before consultation(≥4 d after surgery)was 78.0 mg·L^(-1),and the median CRP after consultation was 26.5 mg·L^(-1),and the difference was statistically significant before and after consultation.CONCLUSION CRP>30.4mg·L^(-1)(≥4 d after surgery)is a more sensitive marker.Continuous assessment of the combined trend of ESR and CRP is essential.The main pathogenic bacteria are gram-positive bacteria,and levofloxacin alone is not recommended.