脊柱外科术后伤口感染病原菌及药敏分析

Distribution and drug susceptibility of pathogens causing wound infections after spine surgery

目的分析脊柱外科术后伤口感染病原菌分布及药敏率,指导脊柱外科术后伤口感染的预防及治疗。方法选择2008-2012年180例脊柱外科术后伤口感染患者男124例,女56例,年龄41～72岁;收集标本后按照《全国临床检验操作规程》进行病原菌分离鉴定,采用K-B法进行药敏试验。结果 180例患者送检标本共分离出病原菌126株,其中革兰阴性菌89株占74.6%;革兰阳性菌32株占25.4%;排名前4位病原菌依次为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌,分别占22.2%、16.7%、13.5%、11.1%;革兰阴性菌中铜绿假单胞菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦及多黏菌素B敏感性最强,耐药率均为0;肺炎克雷伯菌和大肠埃希菌对磺胺甲噁唑/甲氧苄啶、氨苄西林均保持较高耐药性,耐药率>66.7%;革兰阳性菌中金黄色葡萄球菌对青霉素G耐药率>50.0%,对万古霉素的耐药率<20.0%。结论脊柱外科术后伤口感染病原菌以革兰阴性菌为主,为预防感染,应加强消毒、隔离措施,早期感染需及时进行病原菌检查,指导合理用药。

OBJECTIVE To analyze the distribution and drug susceptibility of pathogens causing wound infections after spine surgery so as to guide the prevention and treatment of postoperative wound infections.METHODS A total of 180 cases of patients with wound infections,who underwent the spine surgery from 2008 to 2012,were enrolled in the study,including 124 males and 56 females aged between 41 and 72years old,then the specimens were collected for the isolation and identification of pathogens,and the drug susceptibility testing was performed by using K-B method according to NCLP.RESULTS A total of 126 strains of pathogenic bacteria were isolated from 180 specimens,including 89 strains（74.6%）of gram-negative bacteria and 32 strains（25.4%）of grampositive bacteria.The Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae,and Staphylococcus aureus ranked the top four species of pathogens,accounting for 22.2%,16.7%,13.5%,and 11.1%,respectively.Among the gram-negative bacteria,the P.aeruginosa was most sensitive to cefoperazone/sulbactam,piperacillin/ tazobactam,and polymyxin B,the drug resistance rate was 0;the K.pneumoniae and E.coli remained highly resistant to sulfamethoxazole/trimethoprim and ampicillin,the drug resistance rate was more than 66.7%;among the gram-positive bacteria,the drug resistance rate of S.aureus to penicillin G was higher than 50.0%,and the drug resistance rate to vancomycin was less than 20.0%.CONCLUSIONThe gram-negative bacteria are the predominant pathogens causing wound infections after the spine surgery.To prevent the infections,it is necessary to strengthen the disinfection and isolation interventions and carry out the detection of pathogens in a timely manner so as to guide the reasonable medication.