脊柱外科术后病原菌感染分析

Analysis of pathogenic infection after spinal surgery

目的研究并分析脊柱外科术后病原感染情况以及干预措施。方法选取我院2015-2020年接受脊柱外科手术治疗并发生术后感染的患者183例为研究对象,使用生理盐水对患者手术切口进行擦拭,收集患者血液、分泌物、穿刺液并送检,并对病原菌进行培养与鉴别并进行药敏试验。根据试验结果选择合适的药物进行干预。结果183例患者发生感染的主要类型是切口感染(105例,57.4%),共分离出143株病原菌。其中:75株革兰阳性菌,占52.4%;60株革兰阴性菌,占42.0%;8株真菌,占5.6%。革兰阳性菌对万古霉素(VA)无耐药性,肺炎克雷伯菌对环丙沙星(CIP)、亚胺培南(IPM)和头孢哌酮/舒巴坦(SCF)无耐药性,大肠埃希菌对亚胺培南(IPM)无耐药性。结论脊柱外科术后感染中切口是感染主要部位,金黄色葡萄球菌和肺炎克雷伯菌是主要病原菌,可以使用VA治疗金黄色葡萄球菌感染,使用CIP、IPM、SCF治疗肺炎克雷伯菌感染。

Objective To observe and analyze the pathogenic infection after spinal surgery and the intervention measures.Methods A total of 183patients with postoperative infection who underwent spinal surgery in our hospital from 2015to 2020were selected.The surgical incision was wiped with normal saline,the patient′s blood,secretion and puncture fluid were collected and sent for examination,and the pathogenic bacteria were cultured and identified.Drug sensitivity test was carried out.Then the appropriate drugs were selected for intervention according to the testing results.Results The main type of infection in the 183patients was incision infection,which has 105cases(57.4%).A total of 143strains of pathogenic bacteria were isolated,including 75strains of Gram-positive bacteria,accounting for 52.4%,60strains of Gramnegative bacteria,accounting for 42.0%,and 8strains of fungi,accounting for 5.6%.The resistance rate of Gram-positive bacteria to vancomycin(VA)was 0.The resistances of Klebsiella pneumoniae to ciprofloxacin(CIP),imipenem(IPM)and Cefoperazone/sulbactam(SCF)were 0,and that of Escherichia coli to IPM was 0.Conclusion The infection of incision is the main site of postoperative infection after spinal surgery,and Staphylococcus aureus and Klebsiella pneumoniae are the main pathogens.Staphylococcus aureus can be treated with VA and Klebsiella pneumoniae can be treated with CIP,IPM and SCF.