脊柱手术部位感染病原菌分布及防控措施

Distribution of pathogenic bacteria and prevention measures of spinal surgical site infection

目的分析脊柱手术部位感染病原菌分布及危险因素,为制订感染防控措施提供科学依据。方法通过回顾性分析,对某院实行脊柱手术患者手术部位感染病原菌检测结果进行统计分析,并通过病历对照研究分析手术部位感染危险因素。结果共调查932例脊柱手术患者,发生手术部位感染47例,感染率为5. 04%。切口分泌物中共分离到病原菌52株,其中革兰阳性菌占65. 38%,其余为革兰阴性菌;金黄色葡萄球菌最常见,未检测出对万古霉素耐药的金黄色葡萄球菌。多因素分析显示,年龄> 60岁、肥胖、糖尿病、手术时间> 3 h、失血量> 1 000 ml、输血、融合节段> 3个、住院时间> 15 d为脊柱手术部位感染的危险因素(P <0. 05),其中预防性使用抗菌药物、快速康复为脊柱手术部位感染的保护性因素(P <0. 05)。结论脊柱手术部位感染病原菌以金黄色葡萄球菌最多,感染危险因素明确,预防性使用抗菌药物、施行快速康复可有效减少手术部位感染的发生率。

Objective To analyze the distribution of pathogenic bacteria and their risk factors in spinal surgery site,and to provide scientific basis for infection prevention and control.Methods A retrospective analysis method was used to analyze the test results of pathogenic bacteria in patients with spinal surgery,and the risk factors of infection were analyzed by case-control study.Results A total of 932 spinal surgery cases were investigated,47 cases were infected,and the infection rate was5.04%.A total of 52 pathogens were isolated,of which Gram-positive bacteria accounted for 65.38%,and the rest were Gram-negative bacteria;Staphylococcus aureus was the most detected and showed no drug resistance to vancomycin.Multifactor analysis showed that age>60,obesity,diabetes,operating time>3 h,the amount of blood loss>1000 ml,blood transfusion,fusion segment>3,hospitalization time>15 days were risk factors for infection with spinal surgery site(P<0.05),in which the preventive use of antimicrobial drugs and rapid rehabilitation are protective factors for infection at the site of spinal surgery(P<0.05).Conclusion The main pathogenic bacteria of spinal surgery site infection is Staphylococcus aureus,and the risk factors are clear.Preventive use of antimicrobial drugs and rapid rehabilitation can effectively reduce the incidence of infection in surgical sites.