脊柱手术住院患者术后院内感染特点及影响因素分析

Characteristics of and factors influencing the development of a urinary tract infection in patients after spinal surgery

目的调查脊柱手术住院患者术后院内感染特点及影响因素,指导抗感染防治。方法收集脊柱手术住院患者临床资料,分析感染患者疾病类型。采集患者临床标本,鉴定病原学,K-B法分析主要病原菌耐药性。统计分析感染影响因素。结果 1 511例脊柱手术住院患者中,术后感染108例,感染率7.15%。其中,泌尿系统感染、肺部及呼吸道感染、切口感染、椎间隙感染、菌血症患者数分别为42、34、29、2和1例。共分离110株病原菌,其中包括革兰阴性菌、革兰阳性菌、真菌分别为59、42和9株。革兰阴性菌包括铜大肠埃希菌、鲍曼不动杆菌、绿假单胞菌、其他G^-,各占23.64%、17.27%、7.27%和5.45%;革兰阳性菌包括金黄色葡萄球菌、凝固酶阳性葡萄球菌、表皮葡萄球菌、其他G^+,各占16.36%、10.91%、7.27%和3.64%;真菌均为白色假丝酵母菌。26株大肠埃希菌对氨苄西林、庆大霉素、环丙沙星、头孢他啶、阿米卡星、美罗培南的耐药率分别为53.85%、53.85%、42.31%、34.62%、15.38%和15.38%;18株金黄色葡萄球菌对青霉素、红霉素、庆大霉素、头孢吡肟、利奈唑胺、万古霉素的耐药率分别为55.56%、44.44%、38.89%、22.22%、16.67%和0.00%。大肠埃希菌菌株中毒力因子fyuA、iutA和aer携带分别为12、10和9株。耐药因子TEM、SHV和CTX-M-9携带分别为3、1和2株,未检出CTX-M-1。脊柱手术住院患者术后院内感染发生与年龄、留置尿管时间手术时间、糖尿病和预防性使用抗生素有关,与性别无关。结论术后感染患者中泌尿系统感染居多,主要是大肠埃希菌和金黄色葡萄球菌。缩短手术时间、预防性使用抗生素有利于减少患者院内发生感染风险。

Objective To investigate the characteristics of and factors influencing the development of a urinary tract infection in patients after spinal surgery in order to guide the prevention and treatment of infections. Methods Clinical data on patients who underwent spinal surgery were collected to analyze the type of disease in patients with an infection. Samples of urethral secretions were collected to identify the etiology, and the drug resistance of main pathogens was analyzed using the K-B method. Statistical software was used to analyze factors influencing the incidence of an infection. Results Of 1,511 patients undergoing spinal surgery, 108 developed a urinary tract infection after surgery, for a rate of infection of 7.15%. Forty-two patients had a urinary tract infection, 34 had a lung and respiratory tract infection, 29 had a surgical site infection, 2 had an intervertebral space infection, and 1 had bacteremia. A total of 110 strains of pathogens were isolated, including 59 strains of Gram-negative bacteria, 42 strains of Gram-positive bacteria, and 9 strains of fungi. Escherichia coli accounted for 23.64% of the Gram-negative bacteria, Acinetobacter baumannii accounted for 17.27%, Pseudomonas aeruginosa accounted for 7.27%, and other Gram-negative bacteria accounted for 5.45%. Staphylococcus aureus accounted for 16.36% of the Gram-positive bacteria, coagulase-positive S. aureus accounted for 10.91%, S. epidermidis accounted for 7.27%, and other Gram-positive bacteria accounted for 3.64%. Fungi were all Candida albicans. Twenty-six strains of E. coli were resistant to ampicillin at a rate of 53.85%, to gentamicin at a rate of 53.85%, to ciprofloxacin at a rate of 42.31%, to ceftazidime at a rate of 34.62%, to amikacin at a rate of 15.38%, and to meropenem at a rate of 15.38%. Eighteen strains of S. aureus were resistant to penicillin at a rate of 55.56%, to erythromycin at a rate of 44.44%, to gentamicin at a rate of 38.89%, to cefepime at a rate of 22.22%, to linezolid at a rate of 16.67%, and to vancomycin at a rate of 0.00%. The virulence factor fyua was found in 12 strains of E. coli, iuta was found in 10, and aer was found in 9. The drug resistance factor TEM was found in 3 strains of E. coli, SHV was found in 1, and ctx-m-9 was found in 2. CTX-M-1 was not found in any strains. The incidence of a nosocomial infection was related to age, the duration of an indwelling catheter, operating time, diabetes mellitus, and prophylactic use of antibiotics but not to sex. Conclusion A urinary tract infection was common in patients with a postoperative infection. The main pathogens responsible were E. coli and S. aureus. Shortening the operating time and using antibiotics prophylactically can reduce the risk of nosocomial infection.