脊柱内固定术后深部感染致病菌检出率及影响因素分析  

Detection rate of pathogenic bacteria and its potential risk factors in deep infection after spinal instrumented surgery

作　　者：陈韦东 范吉文 郑明辉[1,2] 凌杜华 张宇婧 钟锦涛 谭炜浩 瞿东滨[1,2] CHEN Weidong;FAN Jiwen;ZHENG Minghui(Division of Spine Surgery,Department of Orthopaedics,Nanfang Hospital,Southern Medical University,510515,Guangzhou)

机构地区：[1]南方医科大学南方医院骨科学科脊柱骨科,广州市510515 [2]南方医科大学南方医院增城分院骨科,广州市511300 [3]南方医科大学第二临床医学院,广州市510515

出　　处：《中国脊柱脊髓杂志》2020年第10期867-871,共5页Chinese Journal of Spine and Spinal Cord

基　　金：国家自然科学基金(编号:81272022)。

摘　　要：目的:分析脊柱内固定术后深部感染致病菌谱及影响致病菌检出率的因素,为提高致病菌检出率、规范临床治疗提供参考。方法:选取2009年1月~2019年1月南方医院骨科学科脊柱骨科诊断为脊柱内固定手术后深部感染病例作为研究对象,分析致病菌检出种类及检出率,探讨年龄、性别、手术类型、手术部位、手术时间、手术节段、感染类型(早发性及迟发性感染)、取样时间(初次手术后至样本收集的时间)、取样前抗生素干预与否、抗生素干预时间(取样前抗生素治疗的天数)等因素对致病菌检出率的影响。结果:符合纳入标准89例患者中,38例血培养或切口组织培养阳性,检出率为42.7%,其中单一病原菌31例,混合感染7例。共培养出47株病原菌,革兰氏阳性细菌26株,革兰氏阴性菌20株,真菌1株。主要致病菌为金黄色葡萄球菌(13株,27.7%)、大肠埃希菌(8株,17.0%)、表皮葡萄球菌(5株,10.6%)、铜绿假单胞菌(5株,10.6%)。感染类型(P=0.002)、取样时间(P=0.044)及抗生素干预(P<0.001)均影响致病菌的检出,差异有统计学意义,而手术类型、手术部位、手术时间、手术节段、抗生素干预时间对检出率无影响(P<0.05)。结论:脊柱内固定术后深部感染致病菌检出率为42.7%,以金黄色葡萄球菌和大肠埃希菌为主,迟发性感染更易培养出致病菌,抗生素干预及取样时间均可影响致病菌检出率。Objectives:To analyze the distribution of pathogenic bacteria deep surgical site infection after spinal instrumented surgery and the potential risk factors affecting the detection rate.Methods:All patients diagnosed with deep surgical site infection after spinal instrumented surgery were selected between January 2009 and January 2019.Distributionand detection rate of pathogenic bacteriawere analyzed.Data including age,sex,surgical indication,surgical region,number of operated vertebrae,operative time,type of infection(early and late onset infection),specimen collection time span(time from the initial operation to sample collection),antibiotic intervention before specimen collection,and antibiotic intervention time span were compared to assess the potential risk factors for reducing detection rate.Results:89 patients met the enrollment criteria,and 38 patients had positive culture result,among which 31 patients suffered mono-infection and 7 patients suffered multi-infection.The detection rate was 42.7%.47 strains of pathogenic bacteria were collected,with 26 strains of Gram-positive bacteria,20 strains of Gram-negative bacteria and 1 strain of fungus.The main pathogens were Staphylococcus aureus(13 strains,27.7%),Escherichia coli(8 strains,17.0%),Staphylococcus epidermidis(5 strains,10.6%),Pseudomonas aeruginosa(5 strains,10.6%).Type of infection(P=0.002),specimen collection time span(P=0.044)and antibiotic intervention(P<0.001)all affected the detection rate of pathogenic bacteria,the difference were statistically significant.Surgical indication,surgical region,number of operated vertebrae,operative time,and antibiotic intervention time span had no effect on the detection rate(P<0.05).Conclusions:The detection rate of pathogenic bacteria was 42.7%.Staphylococcus aureus and Escherichia coliwere the main pathogens.Antibiotic intervention and the time span of specimen collection could affect the detection rate,and the pathogenic bacteria could be more easily cultivated in late-onset infection.

关 键 词：脊柱疾病 内固定术 深部感染 致病菌 检出率 

分 类 号：R619[医药卫生—外科学] R978.1[医药卫生—临床医学]