胸腰椎手术切口感染MRSA病原学分析

Analysis of the etiology of MRSA in thoracolumbar spine surgical site infections

目的分析胸腰椎手术切口感染耐甲氧西林金黄色葡萄球菌病原学情况,指导临床治疗及用药。方法收集117例胸腰椎手术切口感染患者临床资料及标本,分离病原菌并进行耐药性分析。采用统计学分析患者耐甲氧西林金黄色葡萄球菌感染发生因素。结果从患者标本中,共分离到革兰阳性球菌88例(75.21%,88/117),革兰阴性杆菌29例(24.79%,29/117)。88例革兰阳性球菌中,金黄色葡萄球菌71例(60.68%,71/117),其中甲氧西林敏感金黄色葡萄球菌(MSSA)50例,耐甲氧西林金黄色葡萄球菌(MRSA)21例。表皮葡萄球菌12例(10.26%,12/117),其中甲氧西林敏感表皮葡萄球菌(MSSE)4例,甲氧西林耐药表皮葡萄球菌(MRSE)8例。粪肠球菌5例(4.27%,5/117)。革兰阴性杆菌29例,其中大肠埃希菌7例(5.98%,7/117),肺炎克雷伯菌4例(3.42%,4/117),阴沟肠杆菌14例(11.97%,14/117),铜绿假单胞菌4例(3.42%,4/117)。MRSA在脓液、血液、分泌物、穿刺液以及导管样本分离率分别为21.95%、18.92%、14.29%、14.29%、9.09%。MRSA对苯唑西林、头孢曲松、庆大霉素、四环素、环丙沙星、万古霉素的耐药率分别为100.00%、76.19%、66.67%、42.86%、42.86%和0.00%。患者的性别、年龄及治疗中联合用药种类与患者MRSA感染无关(P>0.05),而患者感染MRSA的发生与患者住院时间以及糖尿病有关(P<0.05)。结论胸腰椎手术切口感染患者MRSA感染率较高,脓液是主要样本来源。临床治疗MRSA感染时,可优先选用万古霉素。患者感染MRSA的发生与患者住院时间以及糖尿病有关,临床应给予重视。

Objective To analyze the etiology of methicillin-resistant Staphylococcus aureus causing a thoracolumbar spine surgical site infection in order to guide clinical treatment and drug use.Methods Clinical data on and specimens from 117 patients with a thoracolumbar spine surgical site infection were collected,and the pathogenic bacteria were isolated to analyze their drug resistance.Risk factors for development of a methicillin-resistant S.aureus infection were analyzed statistically.Results Gram-positive cocci were isolated from 88 patients(75.21%,88/117),and Gram-negative cocci were isolated from 71(24.79%,29/117).Of the 88 patients from whom Gram-positive cocci were isolated,S.aureus was isolated from 71(60.68%,71/117).Methicillin-sensitive S.aureus was isolated from 50 patients,and methicillin-resistant S.aureus was isolated from 21.S.epidermidis was isolated from 12 patients(10.26%,12/117).Methicillin-sensitive S.epidermidis was isolated from 4 patients,and methicillin-resistant S.epidermidis was isolated from 8.Enterococcus faecalis was isolated from 5 patients(4.27%,5/117).Gram-negative bacilli were isolated from 29 patients.Escherichia coli was isolated from 7 patients(5.98%,7/117),Klebsiella pneumoniae was isolated from 4(3.42%,4/117),Enterobacter cloacae was isolated from 14(11.97%,14/117),and Pseudomonas aeruginosa was isolated from 4(3.42%,4/117).A total of 21 strains of methicillin-resistant S.aureus were isolated.Twenty-one-point-nine-five percent of strains were isolated from pus,18.92%were isolated from blood,14.29%were isolated from secretions,14.29%were isolated from puncture fluid,and 9.09%were isolated from catheter samples.Methicillin-resistant S.aureus was resistant to oxacillin at a rate of 100.00%,to ceftriaxone at a rate of 76.19%,to gentamicin at a rate of 66.67%,to tetracycline at a rate of 42.86%,to ciprofloxacin at a rate of 42.86%,and to vancomycin at a rate of 0.00%.Patient gender and age and the types of drugs used together in treatment were not related to the development of a methicillin-resistant S.aureus infection(P>0.05),but the development of a methicillin-resistant S.aureus infection was related to the duration of hospitalization and diabetes(P<0.05).Conclusion Patients with a thoracolumbar spine surgical site infection were most often infected with methicillin-resistant S.aureus,and that bacterium was mainly detected in pus samples.Vancomycin should be the treatment of choice for a methicillin-resistant S.aureus infection.The development of a methicillin-resistant S.aureus infection is related to duration of hospitalization and diabetes.