骨科Ⅰ类切口手术部位感染患者的临床和微生物学分析

Analysis of clinical and etiologic features of patients with type I incision surgical site infection in orthopedics department

目的分析并探讨骨科Ⅰ类切口手术部位感染（SSI）患者病原菌的种类及耐药性。方法回顾性分析2005年1月至2013年12月北京大学第三医院骨科发生Ⅰ类切口SSI患者的临床资料，对患者的临床特点、感染的病原菌分布和药物敏感情况进行研究。结果2005年1月至2013年12月骨科共有5．82万例Ⅰ类切口手术患者，其中442例患者发生Ⅰ类切口SSI，感染率为0．8％。感染以老年患者为主，疾病以腰椎管狭窄（21．7％）、颈椎病（20．6％）、腰椎间盘突出（14．0％）最常见。共检出病原菌453株，其中革兰阳性菌占52．9％，革兰阴性菌占45．5％，真菌占1．6％。常见的病原菌依次为金黄色葡萄球菌（25．2%），表皮葡萄球菌（14．1％），大肠埃希菌（11．5％），阴沟肠杆菌（7．3％），铜绿假单胞菌（6．2％），鲍曼不动杆菌（6．0％）。其中耐甲氧西林金黄色葡萄球菌（MRsA）比例为23．7％，耐甲氧西林表皮葡萄球菌（MRSE）比例为43．8％。未发现耐万古霉素、利奈唑胺的金黄色葡萄球菌和表皮葡萄球菌。产超广谱β-内酰胺酶（ESBL）的大肠埃希菌比例为53．8％，产ESBL的肺炎克雷伯菌比例为50．0％。3种主要的肠杆菌科细菌大肠埃希菌、阴沟肠杆菌、肺炎克雷伯菌对亚胺培南、美罗培南的耐药率均为0。铜绿假单胞菌对头孢哌酮／舒巴坦、哌拉西林／他唑巴坦的耐药率较低，均〈10％。鲍曼不动杆菌对米诺环素耐药率为11．1％，对美罗培南、亚胺培南和其他抗菌药物耐药率均〉20％。结论骨科I类切口SSI发生率较低。病原菌中革兰阳性菌和革兰阴性菌各占半数。耐药菌比例较高，经验治疗时需要覆盖这些病原菌。

Objective To explore the types and drug resistance of pathogens in patients with type I incision surgical site infection in orthopedics department. Methods Patients with type I incision surgical site infection in orthopedics department at Peking University Third Hospital from January 2005 to December 2013 were retrospectively collected. Clinical characteristics of patients, distribution and drug resistance of pathogens were analyzed. Results A total of 58.2 thousands patients with type I incision surgical site were hospitalized from January 2005 to December 2013 in orthopedics department, and among them 442 patients had infection in the type I incision surgical site. The infection rate was 0. 8%. Infection was mainly observed in elderly patients. The most common diseases were lumbar canal stenosis （21.7%）, cervical spondylosis （20.6%） and lumbar intervertebral disc herniation （14. 0%）. A total of 453 pathogenic strains were detected, of which 52.9% were gram-positive bacteria, 45.5% were gram- negative bacteria and 1.6 % were fungi, The common pathogens were Staphylococcus aureus （25.2 %）, Staphylococcus epidermidis （14.1%）, Escherichia coli （11.5%）, Enterobacter cloacae （7.3%）, Pseudomonas aeruginosa （6. 2 %） and Acinetobacter baumannii （6. 0 %）. The percentage of Metieillin- resistant Staphylococcus aureus （MRSA） was 23.7%and the percentage of Meticillin-resistantStaphylococcus epidermidis （MRSE） was 43.8%. Vaneomycin or linezolid-resistant Staphylococcus aureus or Staphylococcus epidermidis were not detected. Proportion of extended-spectrum beta- lactamases （ESBL） producing strains in Escherichia coli was 53.8 %, and proportion of ESBL-producing strains in Klebesiella pneumonia was 50. 0%. The resistance rates to impenem and meropenem of the three different species in Enterobacteriaceae, including Escherichia coli, Enterobacter cloacae and Klebsiella pneumonia, were 0. Resistance rates of Pseudomonas aeruginosa to cefoperazone-sulbactam, piperaeillin-tazobaetam were less than 10%. Resistance rate of Acinetobacter baumannii to minoeyline was 11.1% and resistance rates of it to other drugs were more than 20%. Conelusions The rate of type I incision surgical site infection in orthopedics department is low. Gram-positive and gram negative bacteria each account for half of the pathogens. The proportion of resistant pathogens is high and empirical treatment is needed to cover these pathogens.