替考拉宁和万古霉素治疗脊柱后路术后手术深部耐甲氧西林革兰阳性菌感染的临床疗效  

Clinical effects of teicoplanin and vancomycin on treatment of posterior spinal surgery patients with postoperative deep methicillin-resistant gram-positive bacteria infections

作　　者：吴婧 刘小兰 郭德群 王四清 陈建军 周亮亮[2] WU Jing;LIU Xiao-lan;GUO De-qun;WANG Si-qing;CHEN Jian-jun;ZHOU Liang-liang(The First People's Hospital of Yancheng,Yancheng First Hospital,Af filiated Hospital of Nanjing University Medical School,Yancheng,Jiangsu 224000,China)

机构地区：[1]盐城市第一人民医院/南京大学医学院附属盐城第一医院脊柱外科,江苏盐城224000 [2]盐城市第一人民医院/南京大学医学院附属盐城第一医院重症医学科,江苏盐城224000

出　　处：《中华医院感染学杂志》2020年第18期2790-2793,共4页Chinese Journal of Nosocomiology

基　　金：盐城市医学重点基金资助项目(YK2018023)。

摘　　要：目的研究脊柱后路内固定术后手术部位深部耐甲氧西林阳性球菌感染患者使用不同抗生素治疗的效果。方法选择2016年1月-2019年10月盐城市第一人民医院经脊柱后路手术且术后手术部位出现深部感染的患者,且脓液、分泌物及穿刺液检出耐甲氧西林革兰阳性菌感染患者共116例,其中使用替考拉宁治疗60例,使用万古霉素治疗56例。分析深部感染患者检出耐甲氧西林革兰阳性菌分布,比较两组患者治疗后临床疗效、实验室检测指标变化和不良反应发生情况。结果116例脊髓减压术脊柱后入路切口感染患者手术部位的脓液、穿刺液、分泌物共培养出甲氧西林耐药革兰阳性菌116株,主要以耐甲氧西林金黄色葡萄球菌为主;治疗后第7天和第14天两组患者肌酐清除率、AST、WBC计数、PCT、hs-CRP和TNF-α比较差异有统计学意义(P<0.05);替考拉宁组治疗有效率为95%高于万古霉素组治疗有效率的78.57%(P<0.05);治疗后,万古霉素组发生皮疹4例、听力障碍2例和红人综合征2例,替考拉宁组发生皮疹1例,未有听力障碍和红人综合征的发生。结论脊柱后路内固定术后手术部位深部耐甲氧西林革兰阳性菌感染患者抗感染方案选用替考拉宁较万古霉素能够更快地降低感染和炎症指标,有效率更高,同时不良反应发生率更低,在控制耐甲氧西林的革兰阳性球菌导致的深部组织感染中可优先考虑替考拉宁。OBJECTIVE To observe the effects of antibiotics on treatment of posterior spinal fixation surgery patients with postoperative deep methicillin-resistant gram-positive cocci infections.METHODS From Jan 2016 to Oct 2019,totally 116 patients who underwent the posterior spinal surgery and had postoperative deep infection in surgical sites in Yancheng No.1 People′s Hospital were enrolled in the study,the methicillin-resistant gram-positive bacteria were isolated from the pus,secretions and puncture fluid specimens of the patients.60 patients were treated with teicoplanin,and 56 patients were treated with vancomycin.The distribution of methicillin-resistant gram-positive bacteria isolated from the patients with deep infection was observed,and the clinical curative effect,laboratory test indexes and incidence of adverse reactions were compared between the two groups of patients.RESULTS A total of 116 strains of methicillin-resistant gram-positive bacteria were isolated from the pus,puncture fluid and secretions specimens of surgical sites of the 116 spinal cord decompression patients with incision infection of posterior spinal approach,among which methicillin-resistant Staphylococcus aureus strains were dominant.There were significant differences in clearance rate of creatinine,AST,WBC counts,PCT,hs-CRP and TNF-αbetween the two groups of patients after the treatment for 7 and 14 days(P<0.05).The effective rate of treatment of the teicoplanin group was 95%,significantly higher than 78.57%of the vancomycin group(P<0.05).There were 4 cases of skin rash,2 cases of hearing impairment and 2 cases of Red Man Syndrome in the vancomycin group after the treatment;there was 1 case of skin rash and no case of hearing impairment or Red Man Syndrome in the teicoplanin group.CONCLUSION As compared with vancomycin,teicoplanin can more quickly reduce the infection and inflammation indexes of the posterior spinal fixation surgery patients with postoperative deep methicillin-resistant gram-positive bacteria infections,the effective rat

关 键 词：脊柱后路内固定术 深部感染 替考拉宁 耐甲氧西林革兰阳性球菌 

分 类 号：R63[医药卫生—外科学]