脊柱后路内固定术后手术部位深部感染的微生物与药敏学研究

Microorganism and drug sensitivity study of deep surgical site infections after posterior spinal internal fixation

目的研究脊柱后路内固定术后手术部位深部感染的微生物与药敏学。方法选择2010年1月至2015年1月在我院行脊柱后路内固定术后手术部位深部感染患者65例,取所有患者的脓液、分泌物及穿刺液等进行微生物培养,并进行药敏学测试。结果 65例患者微生物培养结果显示,共培养出130株微生物,104株革兰氏阳性球菌,26株革兰氏阴性杆菌;革兰氏阳性球菌对青霉素、克林霉素、红霉素耐药性较高,均高于60%,对甲氧西林、美罗培南、头孢呋辛、头孢噻肟、头孢曲松钠、庆大霉素等抗生素的耐药率为30%~40%;革兰氏阴性杆菌对氨苄西林、头孢唑林、头孢呋辛等抗生素的耐药率均高于80%,对哌拉西林、头孢噻肟、头孢曲松钠、复方磺胺甲恶唑等抗生素的抗药性为50%~60%;革兰氏阳性球菌对万古霉素、利奈唑胺、替考拉宁具有较好的敏感性。结论脊柱后路内固定术后手术部位深部感染微生物以革兰氏阳性球菌为主,革兰氏阳性球菌对万古霉素、利奈唑胺、替考拉宁具有较好的敏感性,适合于长期使用抗生素治疗的患者。

Objective To study the microorganism and drug sensitivity of deep surgical site infections after posterior spinal internal fixation. Methods Sixty-five patients undergoing deep surgical site infections after posterior spinal internal fixation from January 2010 to January 2015 were selected. The pus, secretion and puncture fluid of all the patients were cultured, and the drug sensitivity test was carried out. Results A total of 130 strains of bacteria were obtained,including 104 strains of Gram-positive cocci and 26 strains of Gram-negative bacilli. The Gram-positive cocci had high resistance of more than 60% to penicillin, clindamycin, erythromycin and resistance of 30%~40% to methicillin, meropenem, cefuroxime, cefotaxime, ceftriaxone sodium and gentamicin. The Gram-negative bacilli had high resistance of more than 80% to ampicillin, cefazolin, cefuroxime and relatively high resistance of 50%~60% to piperacillin, cefotaxime, ceftriaxone sodium, compound sulfamethoxazole. Gram-positive cocci were sensitive to vancomycin, linezolid, teicoplanin. Conclusion Microorganisms isolated from surgical site with deep infections after posterior spinal internal fixation are mainly Gram-positive cocci, which are sensitive to vancomycin, linezolid, teicoplanin. The three drugs are suitable for treating patients with long-term use of antibiotics.