脊柱术后耐甲氧西林金黄色葡萄球菌感染的治疗--附8例报告

Treatment of methicillin-resistant Staphylococcus aureus(MRSA) infection after spine surgery: 8 cases report

目的：探讨脊柱术后耐甲氧西林葡萄球菌（MRSA）感染的合理治疗方法。方法：2007年7月～2012年12月共收治8例脊柱术后MRSA感染患者，女6例，男2例，年龄32—72岁，平均54.3岁。8例患者均行彻底清创冲洗、对口置管冲洗引流，根据引流液培养结果决定冲洗量及拔除冲洗管和引流管，同时联合抗生素辅助治疗，在静脉使用广谱抗生素前留取切口分泌物送检细菌培养和药敏试验，待细菌培养和药敏结果明确后调整抗生素，必要时还增加口服抗生素。结果：本组8例MRSA感染患者有1例死亡；另7例患者随访5～43个月，平均21个月，至末次随访时未见感染复发。其中4例经过对口置管冲洗引流后感染获得控制而保留了内置物．而另3例在内置物移除后感染才得到控制。患者总住院时间为26～200d，平均91．8d，有5例因手术部位感染于初次手术出院后再次住院，住院次数最多达5次。静脉抗生素的使用时间为14～144d．平均55．5d：其中有5例联合口服抗生素的时间为11-73d，平均31．4d。8例患者中有4例清创手术次数超过1次，最多达5次，其中1例因多次清创导致严重软组织缺损而采用旋转肌瓣覆盖后治愈。结论：脊柱术后MRSA感染治疗往往相对阑难，常需要增加住院时间、延长抗生素疗程、多次清创手术，甚至移除内置物才能有效控制感染。对于脊柱术后MRSA感染，决定是否移除内置物时主要考虑：①术后感染发生的时间〉30d时考虑移除内置物；②术后清创次数达到3次仍未能很好地控制感染时考虑移除内置物。

Objectives： To investigate the treatment for methicillin-resistant Staphylococcus aureus（MRSA） in- fection after spine surgery. Methods： From July 2007 to December 2012, a total of 8 MRSA infected cases （6 females and 2 males） following spine surgery and with an average age at admission of 54.3 years （range, 32-72 years） was reviewed retrospectively, and their therapeutic results were observed retrospectively. All 8 cases underwent debridement, irrigation and drainage（I ＆ D）. The irrigation volume and time to remove the irrigating/drainage tube depended on the result of cultruing results of drainage. All cases took antibiotics as adjutant therapy, wound secretion was collected for bacterial culturing and drug sensitive test before the use of broad-spectrum antibiotics, and antibiotics would be adjusted according to the result of drug sensitivity test. In some cases, oral antibiotics were used together. Results： One MRSA infection case was dead and 7 cases had wound healed, the 7 cases were followed up for 5-43 months（average, 21 months）, no recurrence of infection was found at last follow-up. Among the 7 cases, 4 cases had the implants maintained, while re- moved in the other 3 cases. The average duration of hospitalization was 91.8 days （range, 26-200 days）, 5 cases readmitted after the primary operation, maximized to 5 times. The average duration of intravenous antibi- otics treatment was 55.5 days （range, 14-144 days）, 5 cases took oral antibiotics together, which lasted for 31.4 days（range, 11-73 days）. Four of those 8 cases required multiple debridement with the maximum of 5 times, one ease eventually turned to undergo museuloeutaneous flap transplantation to cover the complex wound. Conclusions： Due to MRSA＇s resistance to many antibiotics after postoperative spinal infection, prolonged hospitalization and use of amount of antibiotics, multiple debribements, even removement of implants, can be considered. Implants removal should be taken into consideration when： （1）MRSA infection over more than 30 days after primary operation; （2）MRSA infection is still uncontrolled even after more than 3 times of debridement.