脊柱后路开放手术后切口感染病原学分析

目的分析脊柱后路开放手术后切口部位感染的微生物学特点及药物敏感性。方法以解放军北部战区总医院2013年1月至2017年1月收治的行脊柱后路开放手术后出现手术部位感染(SSI)的25例患者为研究对象,分析其感染组织培养及药敏试验结果。结果本研究25例患者共分离出29株致病菌,其中革兰阳性菌(G+)13株,占44.83%;革兰阴性菌(G-)12株,占41.38%;真菌4株,占13.79%。革兰阳性菌对青霉素、红霉素等药物耐药严重,敏感药物为万古霉素、利奈唑胺。革兰阴性菌对氨苄西林、氨曲南等药物耐药严重,相对敏感的药物为美罗培南、哌拉西林/他唑巴坦、β-内酰胺类/β-内酰胺酶抑制剂。结论脊柱后路开放手术感染主要以表皮葡萄球菌、鲍曼不动杆菌、大肠埃希菌为主,等待病原菌培养及药敏结果时可经验性选择对其较为敏感的万古霉素、美罗培南、β-内酰胺类/β-内酰胺酶抑制剂进行治疗,从而降低感染等并发症造成的危害。

Pathogenic analysis of incision infection after posterior spinal open surgery

Objective To analyzed the microbiological characteristics and drug sensitivity of incision infection after posterior spinal open surgery.Methods Twenty-five patients with wound infection after posterior spinal open surgery in general hospital of northern theater command of PLA from January 2013 to January 2017 were selected as the research object.The clinical manifestations of the infection were analyzed,and tissue culture and drug sensitivity tests were performed.Results A total of 29 pathogenic bacteria were isolated from 25 patients,including 13 Gram-positive bacteria(G+),accounting for 44.83%;12 Gram-negative bacteria(G-),accounting for 41.38%;and 4 fungi,accounting for 13.79%.Gram-positive bacteria were highly resistant to penicillin and erythromycin,and the sensitive drugs were vancomycin and linezolid.Gram-negative bacteria were severely resistant to ampicillin and aztreonam,and the relatively sensitive drugs were meropenem piperacillin/tazobactam,β-lactam/β-lactamase inhibitors.Conclusion The infection causes of posterior spinal open surgery are mainly staphylococcus epidermidis,acinetobacter baumannii,and escherichia coli.While waiting for the pathogen culture and drug susceptibility results,vancomycin,meropenem,β-lactam/β-lactamase inhibitors that are more sensitive can be selected for treatment,so as to reduce the harm caused by complications such as infection.