164例椎体手术患者术后切口感染分泌物中致病菌谱的特点及其对药物敏感性分析

Analysis on Characteristics of Pathogenic Bacteria Spectrum and Drug Sensitivity in Infected secretions of Incision in 164 Patients with Vertebral Body Surgery

目的:分析椎体手术患者术后切口感染分泌物中致病菌谱的特点及其对药物敏感性。方法:选取医院2014年3月—2017年5月间收治的行椎体手术后伴有伤口感染患者164例临床资料,分析其患者切口感染分泌物中病原菌培养、分离及其药敏试验结果中主要革兰阴性菌、革兰阳性菌对不同抗菌药物的耐药情况。结果:164例术后患者分泌物中,分离出病原菌184株,其中革兰阴性菌(占73.37%)以铜绿假单胞菌、肺炎克雷伯菌和鲍曼不动杆菌为主,革兰阳性菌(占26.63%)以金黄色葡萄球菌为主;革兰阳性菌中金黄色葡萄球菌对万古霉素、青霉素的耐药率高达100.00%,而对头孢吡肟、头孢哌酮的耐药率分别达58.33%和62.50%;而革兰阴性菌中铜绿假单胞菌、肺炎克雷伯菌和鲍曼不动杆菌对美罗培南、亚胺培南的耐药率均高于90.00%。结论:椎体手术患者术后切口感染致病菌主要为金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌和鲍曼不动杆菌感染,且感染致病菌对万古霉素、青霉素、美罗培南、亚胺培南几乎均无敏感性,属完全耐药;临床应根据感染致病菌的耐药情况合理选用敏感抗菌药物治疗,以确保其抗感染的疗效。

Objective: To analyze the characteristics of pathogenic bacteria spectrum and drug sensitivity in infected secretions of incision in 164 patients who received vertebral body surgery. Methods: The clinical data of 164 patients with wound infection after vertebra surgery admitted to the hospital from March 2014 to May 2017 were selected to analyze the culture and isolation of pathogenic bacteria in the infected secretion from the incision and the drug sensitivity test results of the main Gram-negative bacteria and Gram-positive bacteria against different antibacterial drugs. Results:184 strains of pathogenic bacteria were isolated from the secretions of 164 patients after surgery, in which the Gram-negative bacteria(73.37%) were mainly Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii,and the Gram-positive bacteria(26.63%) were mainly Staphylococcus aureus. The drug resistance rates of Staphylococcus aureus to vancomycin and penicillin in Gram-positive bacteria were as high as 100.00%, while the drug resistance rates of cefepime and cefoperazone were 58.33% and 62.50% respectively. The drug resistance rates of Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii to meropenem and imipenem were all higher than90% in Gram-negative bacteria. Conclusion: The infective pathogens of postoperative incision infection in patients who received vertebral body surgery were mainly caused by Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinetobacter baumannii, and the infective pathogens showed almost no sensitivity to vancomycin,penicillin, meropenem and imipenem, and were completely drug-resistant. In order to ensure the effectiveness of anti-infection, sensitive antibiotics should be selected based on the drug resistance of pathogenic bacteria.