骨科术后手术部位MRSA感染的临床特征与耐药性分析

Clinical characteristics and drug resistance analysis of MRSA surgical site infections in orthopedic patients

目的探讨骨科术后手术部位耐甲氧西林金黄色葡萄球菌(MRSA)感染的临床特征和耐药性情况。方法回顾性分析2015年1月至2019年12月福州市第二医院收治的72例骨科术后手术部位MRSA感染患者,统计患者的流行病学资料、临床表现、实验室检查(血常规、C反应蛋白、血沉、微生物培养及药敏试验)、影像学检查、抗菌药物治疗种类及疗程、疾病转归及随访结果等。结果骨科手术共100582例,术后手术部位MRSA感染共72例,感染率为0.072%。早期感染65例,迟发性感染7例。本组患者总住院时间平均[41.0(28.3,57.5)]d,住院次数平均[2.0(1.0,2.0)]次,住院总花费平均[56167.6(36594.7,83077.8)]元。MRSA菌株对万古霉素、利奈唑胺、吗啉噁酮、甲氧苄胺嘧均敏感,对头孢西丁、苯唑西林、氨苄西林、阿莫西林/克拉维酸和青霉素均耐药,而对其他抗菌药物存在不同程度的耐药。治疗包括静脉或口服抗菌药物、伤口引流换药、清创缝合、取出内固定等方法,抗菌药物使用时间平均[21.0(14.0,33.0)]d,清创平均[1.0(0,2.0)]次,61例有内固定植入的患者中19例移除内固定后感染才得到控制。所有患者均治愈,经7~62个月,平均(23.7±8.4)个月随访,至末次随访时未见感染复发。结论骨科术后手术部位MRSA感染的发生率较低,但可导致切口延迟愈合、多次清创手术、住院时间和费用增加等严重后果。尽早行清创手术、联合敏感抗菌药物治疗,可以取得良好的临床效果。其中,抗菌药物推荐使用万古霉素、利奈唑胺、吗啉噁酮和甲氧苄胺嘧等。

Objective To investigate the clinical characteristics and drug resistance of methicillin-resistant staphylococcus aureus(MRSA)infection after orthopedic surgery.Methods A retrospective analysis was performed on 72 patients with MRSA surgical site infection after orthopedic surgery admitted to Fuzhou Second Hospital from January 2015 to December 2019.The epidemiological data,clinical manifestation,laboratory examination(blood routine,C-reactive protein,erythrocyte sedimentation rate,microbial culture and drug sensitivity test),imaging examination,type and course of antibacterials,disease outcome and follow-up results of the patients were analyzed.Results Out of 100582 patients who underwent orthopedic surgery,72(0.072%)developed MRSA surgical site infection.There were 65 patients with early-onset infection and 7 with late onset.The average length of hospitalization was(41.0[28.3,57.5])d,the average number of hospitalization was(2.0[1.0,2.0])times,and the average total hospitalization cost was(56167.6[36594.7,83077.8])yuan.MRSA strains were sensitive to vancomycin,linezolid,morinoxanone and methoxybenzoyl,resistant to cefoxitin,benzacillin,ampicillin,amoxicillin/clavulanic acid and penicillin,and had varying degrees of resistance to other antibacterials.The treatment included intravenous or oral antibiotics,wound drainage and dressing change,debridement and suture,and removal of internal fixation,etc.The average duration of antibacterials use was(21.0[14.0,33.0])d,and the average debridement was(1.0[0,2.0])times.Among 61 patients with internal fixation implants,19 infections was controlled only after removing of internal fixation.All patients were cured and no recurrence of infection was observed at the last follow-up after 7-62 months,mean(23.7±8.4)months.Conclusions The incidence of MRSA surgical site infections in orthopedic patients is low,but it can lead to delayed incision healing,multiple debridement operations,increased hospital stay and cost,etc.Early debridement combined with sensitive antibacterials therapy can achieve good clinical results.Antibacterials,such as,vancomycin,linezolid,morinoxone and trimethoxymethyl,were recommended.