脊柱外科手术术后伤口感染致病菌分布及药物敏感性

Analysis of distribution and drug sensitivity of wound infection pathogens after spinal surgery

目的分析脊柱手术术后切口感染的致病菌分布特点及药物敏感性,为临床合理用药提供指导。方法收集2004年6月—2014年6月在第二军医大学长海医院骨科行脊柱手术后发生切口感染的165例患者的临床资料,回顾性分析其切口分泌物或脓液的细菌培养药物敏感实验结果。结果共培养分离出致病菌173株。其中革兰阴性菌(G-)114株(65.9%),前3位分别是铜绿假单胞菌32株(18.5%)、鲍曼不动杆菌28株(16.2%)、肺炎克雷伯杆菌21株(12.1%);革兰阳性菌(G+)54株(31.2%),前3位分别是金黄色葡萄球菌22株(12.7%)、凝固酶阴性葡萄球菌10株(5.8%)及表皮葡萄球菌8株(4.6%);真菌感染5株(2.9%)。革兰阴性菌对亚胺培南、美罗培南敏感性最高,对青霉素敏感性最低,对氨苄西林、哌拉西林敏感性也较低。革兰阳性菌对万古霉素敏感性最高,对青霉素敏感性最低。结论革兰阴性菌及革兰阳性菌在脊柱手术后切口感染中均较常见,且革兰阴性菌较革兰阳性菌所占比例更高,临床应根据细菌培养和药敏实验结果合理选用抗生素。

Objective To analyze the distribution features and drug sensitivity of wound infection pathogens after spinal surgery to provide the reference for rational administration in clinical practice.Methods The clinical data of 165 patients who were hospitalized in department of orthopedics of Changhai hospital,Second Military Medical University from June 2004 to June 2014,and the distribution and drug sensitivity test results of pathogenic bacteria in incision secretion or pus were analyzed retrospectively.Results Totaly 173 strains of pathogens were isolated. Among these 173 strains of pathogens,114（65.9%） were gram-negative bacteria（G^-）,54（31.2%） were gram-positive bacteria（G^＋） and 5（2.9%） were fungi. The major gram-negative bacteria werePseudomonas aeruginosa（32/173,18.5%）,Acinetobacter baumannii（28/173,16.2%）,and Klebsiella pneumonia（21/173,12.1%）. The major gram-positive bacteria wereStaphylococcus aureus（22/173,12.7%）, coagulase negativeStaphylococcus（10/173,5.8%） andStaphylococcus epidermidis（8/173,4.6%）. The most sensitive antibiotics for gram-negative bacteria were imipenem and meropenem,and the sensivity-lowest was penicilin. Ampicilin and piperacilin have lower sensitivity for gram-negative bacteria. While the most sensitive antibiotic for gram-positive bacteria was vancomycin,and the lowest sensitive was also penicilin.Conclusion Gram-positive bacteria and gram-negative bacteria can both be seen in patients with postoperative wound infection,and gram-netative bacteria have higher proportion than gram-positive bacteria. The rational use of antibiotics should be based on the results of bacterial culture and drug-sensitivity test.