后路脊柱术后早期感染病原学与临床治疗效果分析

Etiological characteristics of early infections in patients undergoing posterior spinal surgery and effect of clinical treatment

目的探讨后路脊柱手术患者术后切口感染临床特征、病原学特点,并分析不同治疗方案临床效果,为临床诊治提供参考依据。方法选择2007年3月-2014年8月498例脊柱后路手术患者,分析其术后发生切口感染的类型、临床特征、诊治结局以及病原学特点。结果 498例患者感染43例,感染率8.63%;30例患者送检标本共分离出32株病原菌,革兰阴性菌15株占46.87%,其中大肠埃希菌6株占18.75%、鲍氏不动杆菌3株占9.38%,革兰阳性菌17株占53.13%,其中金黄色葡萄球菌12株占37.50%;革兰阴性菌对妥布霉素、阿莫西林、庆大霉素等耐药率达100.00%,对亚胺培南耐药率很低,为0;革兰阳性菌对万古霉素、利福平等耐药率较低,其中金黄色葡萄球菌对万古霉素耐药性为0;所有感染患者经过治疗后均好转,经随访3个月,全部痊愈,未见复发。结论金黄色葡萄球菌是后路脊柱手术患者早期切口感染的主要病原菌,扩创并持续灌注引流联合万古霉素类抗菌药物治疗深部感染患者是主要治疗方案。

OBJECTIVE To explore the clinical characteristics and etiological characteristics of postoperative incision infections in the patients undergoing posterior spinal surgery and observe the clinical effects of different treatment programs so as to provide guidance for the clinical diagnosis and treatment .METHODS A total of 498 patients who underwent the posterior spinal surgery from Mar 2007 to Aug 2014 were enrolled in the study ,then the types of the postoperative incision infections ,clinical characteristics ,treatment outcomes ,and etiological characteristics were analyzed .RESULTS The infections occurred in 43 of 498 patients ,with the infection rate of 8 .63% .Totally 32 strains of pathogens have been isolated from the submitted specimens obtained from 30 patients ,including 15 （46 .87% ） strains of gram-negative bacilli and 17 （53 .13% ） strains of gram-positive bacilli ; there were 6 （18 .75% ） strains of Escherichia coli and 3 （9 .38% ） strains of Acinetobacter baumannii ; there were 12 （37 .50% ） strains of Staphylococcus aureus .The drug resistance rates of the gram-negative bacilli to tobramycin , amoxicillin ,and gentamicin were as high as 100 .00% ,while the drug resistance rate to imipenem was 0 .The drug resistance rates of the gram-positive bacteria to vancomycin and rifampicin were low ,and the drug resistance rate of the S .aureus to vancomycin was 0 .All the cases of infection recovered after the symptomatic treatment ,and a 3-month follow-up showed that all the cases were cured without case of recurrence .CONCLUSION The S .aureus is the predominant species of pathogen causing early incision infection in the patients undergoing posterior spinal sur -gery .The derbridement and continuous infusion combined with vancomycin is the major treatment program for the patients with deep infections .