脊柱术后医院感染病原菌特征与危险因素分析

Distribution of pathogens causing postoperative nosocomial infections in spinal surgery patients and risk factors

目的探讨脊柱术后医院感染病原菌特征及相关危险因素,为临床预防与治疗提供参考。方法回顾性分析2008年10月-2013年10月在医院行脊柱外科手术的497例患者临床资料,记录感染部位、病原菌分布及其耐药性,并分析引起医院感染的高危因素。结果 497例脊柱手术患者中发生医院感染25例,感染率5.03%,感染部位以上呼吸道、泌尿道、切口感染为主;25例医院感染患者共分离出41株病原菌,其中革兰阴性菌22株占53.7%,革兰阳性菌15株占36.6%,真菌4株占9.7%;铜绿假单胞菌对亚胺培南、美罗培南的耐药率较低,革兰阳性菌对万古霉素耐药率较低;多因素分析显示,手术时间、合并基础疾病是医院感染独立危险因素,术前抗菌药物预防是医院感染保护因素。结论脊柱术后患者医院感染病原菌以革兰阴性菌为主,手术时间、合并基础疾病是医院感染独立危险因素,术前抗菌药物预防是医院感染保护因素。

OBJECTIVE To explore the characteristics of pathogens causing postoperative nosocomial infections in spinal surgery patients and analyze the related risk factors so as to provide guidance for clinical prevention and treatment .METHODS The clinical data of 497 patients who underwent the spinal surgery in the hospital from Oct 2008 to Oct 2013 were retrospectively analyzed ,then the infection sites ,distribution of the pathogens ,and drug resistance were recorded ,and the high risk factors for the nosocomial infections were analyzed .RESULTS The nos‐ocomial infections occurred in 25 of 497 spinal surgery patients with the infection rate of 5 .03% .The upper respir‐atory tract ,urinary tract ,and incision were the major infection sites .A total of 41 strains of pathogens have been isolated from the 25 patients with nosocomial infections ,including 22 （53 .7% ） strains of gram‐negative bacteria , 15 （36 .6% ） strains of gram‐positive bacteria ,and 4 （9 .7% ） strains of fungi .The drug resistance rates of the Pseudomonas aeruginosa strains to imipenem and meropenem were relatively low ,and the drug resistance rate of the gram‐positive bacteria to vancomycin was relatively low .The multivariate analysis indicated that the operation duration and complication of underlying disease were the independent risk factors for the nosocomial infections and that the preoperative antibiotic prophylaxis was the protective factor .CONCLUSION The gram‐negative bacteria are dominant among the pathogens causing postoperative nosocomial infections in the spinal surgery patients .The operation duration and complication of underlying disease are the independent risk factors for the nosocomial infec‐tions ,and the preoperative antibiotic prophylaxis is the protective factor .