腰椎后路融合内固定术后切口深部感染病原菌及局部抗菌药物治疗研究

Pathogenic bacteria and local antibiotic treatment of deep surgical site infection after posterior lumbar fusion and internal fixation

目的 探讨腰椎后路融合内固定术后早期切口深部感染病原菌分布特征及局部应用抗菌药物的疗效。方法 前瞻性选取2020年5月至2022年5月于我院行腰椎后路融合内固定术后并发早期感染的60例患者,收集患者感染部位分泌物进行细菌培养,分析病原菌分布特征及主要病原菌耐药性。将患者随机分为对照组和观察组,观察组(30例)采用清创联合抗菌药物局部持续灌注引流治疗,对照组(30例)采用清创联合灌注等量生理盐水治疗,对比2组治疗效果。结果 60例样本中检出病原菌90株,其中革兰氏阳性菌30株(33.33%),以金黄色葡萄球菌(20.00%)为主要致病菌;革兰氏阴性菌56株(62.22%),以铜绿假单胞菌(28.89%)为主要致病菌;真菌4株(4.44%)。革兰氏阴性菌中,铜绿假单胞菌对庆大霉素、环丙沙星及氨苄西林耐药性较高,大肠埃希菌对头孢唑林耐药性较高,肺炎克雷伯菌对庆大霉素耐药性较高。革兰氏阳性菌中,金黄色葡萄球菌对氨苄西林和青霉素耐药性较高,表皮葡萄球菌对万古霉素耐药性较高,凝固酶阴性葡萄球菌对氨苄西林、红霉素耐药性较高。2组患者治疗后VAS评分、ODI显著降低(P<0.05);体温及WBC、CRP、PCT、ESR水平均明显改善(P<0.05),且观察组改善情况优于对照组。与对照组比较,观察组患者灌注引流时间、引流管放置时间、静脉使用抗菌药物时间及住院时间均明显缩短(P<0.05),但2组患者切口愈合时间无显著差异(P>0.05)。结论 腰椎后路融合内固定术后早期切口深部感染多以金黄色葡萄球菌及铜绿假单胞菌为主,清创联合抗菌药物局部持续灌注引流治疗感染疗效可靠。

Objective To investigate the distribution characteristics of pathogenic bacteria in early deep surgical site infection after posterior lumbar fusion and internal fixation and the effect of local antibiotic treatment.Methods A total of 60 patients with early infection after posterior lumbar fusion and internal fixation in our hospital from May 2020 to May 2022 were prospectively selected.The secretions of the infected site of patients were collected for bacterial culture,and the distribution characteristic of pathogenic bacteria and the drug resis⁃tance of main pathogenic bacteria were analyzed.The patients were randomly divided into the control group and the observation group.The observation group(30 cases)was treated with debridement combined with antibiotics local continuous perfusion and drainage,while the control group(30 cases)was treated with debridement combined with perfusion of equal amount of normal saline.The treatment effects of the two groups were compared.Results A total of 90 strains of pathogenic bacteria were detected in 60 samples,including 30 strains(33.33%)of Gram-positive bacteria,of which Staphylococcus aureus was the main pathogenic bacteria(20.00%);there were 56 strains(62.22%)of Gram-negative bacteria,of which Pseudomonas aeruginosa was the main pathogenic bacteria(28.89%);4 strains(4.44%)of fungi.Among gram-negative bacteria,Pseudomonas aeruginosa was highly resistant to gentamicin,ciprofloxacin and ampicillin,Escherichia coli was highly resistant to cefazolin,and Klebsiella pneumoniae was highly resistant to gentamicin.Among gram-positive bacteria,Staphylococcus aureus was highly resistant to ampicillin and penicillin,Staphylococcus epidermidis was highly resistant to vancomycin,and Coagulase-negative staphylococcus was highly resistant to ampicillin and erythromycin.After treatment,the VAS score and ODI of patients in the two groups decreased significantly(P<0.05),and the body temperature,WBC,CRP,PCT and ESR were significantly improved(P<0.05),and the improvements in the observation group were better than those in the control group.Compared with the control group,the perfusion drainage time,drainage tube placement time,intravenous antibiotic use time and hospitalization time of patients in the observation group were significantly shortened(P<0.05);but there was no significant difference in the wound healing time between the two groups(P>0.05).Conclusion Staphylococcus aureus and Pseudomonas aeruginosa are the main pathogenic bacteria in early deep surgical site infection after posterior lumbar fusion and internal fixation,and debridement combined with antibiotics local continuous perfusion and drainage have a reliable effect on infection.