血清维生素D降低的脊柱内固定术后肺部感染患者的病原菌分布与耐药性分析

Analysis of pathogenic bacteria distribution and drug resistance of serum vitamin D decreased in patients with pulmonary infection after spinal internal fixation

目的:探讨血清维生素D水平对脊柱内固定手术患者肺部感染的影响及感染病原菌分布及药物敏感性.方法:选取2017年4月~2019年4月于我院接受治疗的266例脊柱内固定手术患者为研究对象,按照术后是否发生肺部感染分为感染组(n=52)和未感染组(n=214).采用高效液相色谱串联质谱仪检测患者总维生素D,维生素D2,维生素D3水平,同时采集患者痰标本进行细菌培养并鉴定病原菌种类.对主要病原菌进行常用抗菌药物药物敏感性试验.结果:感染组和未感染组患者术前总维生素D,维生素D2,维生素D3及术后维生素D.对比不具有统计学意义(P>0.05),术后感染组总维生素,维生素D3水平均显著低于未感染组,具有统计学意义(P<0.05).52例脊柱内固定术后肺部感染患者共分离出64株病原菌,其中革兰阴性菌43株占比67.19%,以铜绿假单胞菌和鲍氏不动杆菌为主;革兰阳性菌18株占比28.13%,以金黄色葡萄球菌为主.铜绿假单胞菌对庆大霉素,头孢他啶,头孢克洛,头孢呋辛,环丙沙星等药物耐药性较高,鲍氏不动杆菌对庆大霉素,头孢曲松,头孢他啶,头孢呋辛,环丙沙星药物耐药性较高.结论:脊柱内固定术后肺部感染患者血清维生素D显著降低,其感染病原菌以革兰阴性菌为主,且对常用抗菌药物耐药性较高,临床医师应根据药敏结果合理选药.

Objective:To investigate the effect of serum vitamin D level on pulmonary infection,pathogen distribution and drug sensitivity in patients undergoing spinal internal fixation.Methods:A total of 266 patients with spinal internal fixation who received treatment in our hospital from April 2017 to April 2019 were selected as the research subj ects,and were divided into infected group(n=52)and uninfected group(n=214)according to whether pulmonary infection occurred after surgery.The levels of total vitamin D,vitamin D2 and vitamin D3 were determined by high performance liquid chromatography tandem mass spectrometry.Meanwhile,sputum samples of the patients were collected for bacterial culture and pathogen identification.The susceptibility test of common antibacterial agents was carried out on the main pathogenic bacteria.Results:There was no statistical significance in the comparison of preoperative total vitamin D,vitamin D2,vitamin D3 and postoperative vitamin D2 between the infected group and the uninfected group(P>0.05),and the postoperative levels of total vitamin D and vitamin D3 in the infected group were significantly lower than those in the uninfected group(P<0.05)A total of 64 strains of pathogenic bacteria were isolated from 52 patients with pulmonary infection after spinal internal fixation,among which 43 strains of Gram-negative bacteria accounted for 67.19%,and the main strains were Pseudomonas aeruginosa and Acinetobacter baumannii.18 strains of gram-positive bacteria accounted for 28.13%,and staphylococcus aureus was the main strain.Pseudomonas aeruginosa had higher drug resistance to gentamicin,ceftazidime,cefclo,cefuroxime,ciprofloxacin,while Acinetobacter baumannii had higher drug resistance to gentamicin,ceftriaxone,ceftazidime,cefuroxime,ciprofloxacin.Conclusion:The serum vitamin D of patients with pulmonary infection after spinal internal fixation was significantly reduced,and the pathogens of infection were mainly Gram-negative bacteria,and the drug resistance to commonly used antibacterial agents was high.Clinicians should reasonably select drugs according to the drug sensitivity results.