腰椎后路固定融合术深部切口感染病原菌及危险因素

Pathogens and risk factors for surgical site deep infection in patients undergoing posterior lumbar interbody fusion

目的探究腰椎后路固定融合术深部切口感染(SSDI)的病原菌分布并分析危险因素。方法回顾性分析2017年3月-2020年3月在杭州市萧山区中医院行腰椎后路固定融合术且随访≥1年的患者临床资料,根据SSDI诊断标准确定发生SSDI病例,分析其病原菌分布,并采用单因素分析和多因素Logistic回归模型分析患者发生SSDI的危险因素。结果350例患者中发生SSDI者20例,共分离出病原菌23株,其中革兰阳性菌株16株,占比69.56%,以金黄色葡萄球菌、表皮葡萄球菌为主;革兰阴性菌株6株,占比26.09%,以大肠埃希菌为主;真菌1株,占比4.35%。单因素分析显示,年龄、体质量指数(BMI)、糖尿病、饮酒、手术时间、失血量、术前血清白蛋白均与腰椎后路固定融合术患者发生SSDI有关(P<0.05)。Logistic回归分析显示,BMI、合并糖尿病均是腰椎后路固定融合术患者发生SSDI的危险因素(P<0.05)。结论医院腰椎后路固定融合术患者发生SSDI以革兰阳性菌为主要菌种,BMI≥25 kg/m^(2)、合并糖尿病均是腰椎后路固定融合术患者发生SSDI的危险因素。

OBJECTIVE To explore the distribution of pathogens and risk factors for surgical site deep infection(SSDI)in patients undergoing posterior lumbar interbody fusion.METHODS The clinical data were collected from the patients who underwent posterior lumbar interbody fusion in Hangzhou Xiaoshan Traditional Chinese Medicine Hospital from Mar 2017 to Mar 2020 and received follow-up for no less than 1 year.The diagnosis of SSDI cases was confirmed based on the SSDI diagnosis criteria,the distribution of pathogens was analyzed,and the univariate analysis and multivariate logistic regression model analysis were performed for the risk factors for SSDI.RESULTS Among 350 patients,20 had SSDI.Totally 23 strains of pathogens were isolated,16(69.56%)of which were gram-positive bacteria,6(26.09%)were gram-negative bacteria,and 1(4.35%)was fungus.Staphylococcus aureus and Staphylococcus epidermidis were the predominant species of gram-positive bacteria;Escherichia coli was dominant among the gram-negative bacteria.Univariate analysis showed that the occurrence of SSDI was associated with the age,body mass index(BMI),diabetes mellitus,alcohol drinking,operation duration,blood loss volume and preoperative serum albumin(P<0.05).Logistic regression analysis indicated that BMI and complication with diabetes mellitus were the risk factors for SSDIin the patients undergoing posterior lumbar interbody fusion(P<0.05).CONCLUSION The gram-positive bacteria are dominant among the pathogens isolated from the posterior lumbar interbody fusion patients with SSDI.The BMI no less than 25 kg/m^(2)and complication with diabetes mellitus are the risk factors for SSDI in the patients undergoing posterior lumbar interbody fusion.