PLIF/TLIF手术后手术部位感染发病率和病原菌的季节变化

The incidence of surgical site infection and seasonal variation of pathogenic bacteria after PLIF/TLIF operation

目的探讨后路PLIF/TLIF手术患者手术部位感染(surgical site infection,SSI)的发病率及病原菌季节变化。方法选择2016年1月~2020年12月在本院接受PLIF/TLIF手术的462例患者作为研究对象,观察SSI发生率。收集患者手术方式(PLIF或TLIF)、手术医师、手术季节、手术时间、平均估算失血量、年龄、性别、体质量指数(body mass index,BMI)、美国麻醉医师协会(American Association of anesthesiologists,ASA)分级、医学共病、融合节段等资料,采用卡方检验和多因素Logistic回归分析观察季节因素对SSI的影响。结果462例患者发生SSI 29例,发生率6.28%。不同季节间,夏季SSI发生率高于非夏季手术患者(P<0.05);此外,夏季SSI患者的耐甲氧西林金黄色葡萄球菌检出率显著高于非夏季SSI患者(P<0.05)。多因素Logistic回归分析显示,剔除混杂因素后,夏季是PLIF/TLIF术后发生SSI的独立风险因素(P<0.05);影响SSI发生的其他因素包括糖尿病、融合节段≥2个节段(P<0.05)。结论夏季PLIF/TLIF术后的SSI发生率明显高于其他季节,金黄色葡萄球菌/耐甲氧西林金黄色葡萄球菌感染为常见病原菌。

Objective To investigate the incidence rate of surgical site infection(SSI)and seasonal changes of pathogens in patients undergoing PLIF/TLIF.Methods From January 2016 to December 2020,462 patients who received PLIF/TLIF in our hospital were selected in this research.The incidence rate of SSI was observed,and the clinical data of operation mode(PLIF or TLIF),surgeon,operation season,operation time,average estimated blood loss,age,gender,body mass index(BMI),American Association of anesthesiologists(ASA)grade,medical comorbidity,fusion segment and so on were collected.Chi square test and multivariate logistic analysis were used to observe the influence of seasonal factors on SSI.Results There were 29 SSI cases in 462 patients,with an incidence rate of 6.28%.The incidence of SSI in summer was higher than that in non-summer surgical patients(P<0.05).In addition,the detection rate of methicillin-resistant Staphylococcus aureus in summer SSI patients was significantly higher than that in non-summer SSI patients(P<0.05).Multivariate logistic regression analysis showed that summer was an independent risk factor for SSI after PLIF/TLIF surgery,excluding confounding factors(P<0.05).Other factors affecting the occurrence of SSI included diabetes,fusion segments≥2 segments(P<0.05).Conclusion The incidence rate of SSI after PLIF/TLIF surgery in summer is significantly higher than in other seasons,and Staphylococcus aureus/methicillin-resistant Staphylococcus aureus infection is a common pathogen.