老年胸腰椎骨折患者术后切口感染发生率及病原学特征

Incidence and etiological characteristics of postoperative incision infection in elderly patients with thoracolumbar fractures

目的 探讨分析老年胸腰椎骨折患者术后切口感染情况以及病原学特点。方法 选择2014年5月至2019年3月378例行胸腰椎骨折术治疗的老年患者作为研究对象,统计其中出现术后切口感染患者数目,并分析感染部位病原学特点并进行药敏性分析,采用Logistic回归分析老年胸腰椎骨折患者术后切口感染的危险因素。结果 378例老年患者术后切口感染36例,术后切口感染发生率为9.52%;切口感染分泌物病原菌分离鉴定结果显示36例患者中分离出致病菌46株,其中的革兰阳性菌20株(43.48%),革兰阴性菌26株(56.52%),革兰阳性菌中以金黄色葡萄球菌为主(11株),革兰阴性菌中以大肠埃希菌为主(14株);药敏性结果显示革兰阳性菌对呋喃妥因、万古霉素、替考拉宁药敏性约为90%,革兰阴性菌对亚胺培南、美罗培南药敏性为100%;Logistic回归分析结果显示BMI(≥28 kg/m^2)、有糖尿病史、手术时间≥2 h、术中出血量≥1 000 ml为老年患者术后切口感染的独立危险因素(P<0.05)。结论 老年胸腰椎骨折患者术后切口感染病原菌分类较多且药敏性普遍较低,术后切口感染的危险因素较多,根据药敏性合理选择抗菌药物以减低感染发生率。

Objective To investigate and analyze the postoperative incision infection and etiological characteristics of elderly patients with thoracolumbar fractures.Methods From May 2014 to March 2019,378 elderly patients with thoracolumbar fractures underwent surgical treatment were selected as the research objects.The number of patients with postoperative incision infection was counted,and the pathogenic characteristics of infection site and drug sensitivity were analyzed.The risk factors of postoperative incision infection in elderly patients with thoracolumbar fracture were analyzed by Logistic regression.Results There were 36 cases of postoperative incision infection in 378 elderly patients,the incidence of postoperative incision infection was 9.52%;46 strains of pathogenic bacteria were isolated from 36 patients,including 20 strains of G^+ bacteria(43.48%),26 strains of G^-bacteria(56.52%).The main G^+ bacteria were Staphylococcus aureus(11 strains),and the main G^-bacteria were Escherichia coli(14 strains).Drug sensitivity test showed that the sensitivity of G^+ bacteria to nitrofurantoin,vancomycin and teicoplanin was about 90%,and that of G^-bacteria to imipenem and meropenem was 100%.Logistic regression analysis showed that BMI(≥ 28 kg/m^2),history of diabetes mellitus,operation time ≥ 2 h and intraoperative blood loss ≥ 1 000 ml were independent risk factors of postoperative incision infection in elderly patients(P<0.05).Conclusion There are more pathogenic bacteria and lower drug sensitivity in elderly patients with thoracolumbar fracture.There are many risk factors for postoperative incision infection.Antimicrobial agents should be selected according to drug sensitivity to reduce the incidence of infection.