腰椎手术前MSSA筛查对手术部位感染率的影响  

Influence of MSSA screening before lumbar surgery on the infection rate of surgical site

作　　者：杨玉峰 徐基涛 齐广明 YANG Yu-feng;XU Ji-tao;QI Guang-ming(Department of Orthopedics,the Second People's Hospital of Xinxiang,Xinxiang,Henan,453000,China)

机构地区：[1]新乡市第二人民医院骨一科,河南新乡453000

出　　处：《颈腰痛杂志》2023年第2期155-158,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：宁夏回族自治区自然科学基金(编号:NZ16212)。

摘　　要：目的探讨腰椎手术前甲氧西林敏感金黄色葡萄球菌(methicillin sensitive Staphylococcus aureus,MSSA)筛查对手术部位感染(surgical site infection,SSI)发生率的影响。方法选取2014年1月~2018年12月本院行腰椎后路手术的734例腰椎退行性疾病患者作为对照组,选取2019年1月~2021年12月本院行择期腰椎手术的587例患者作为研究组;对照组术前未进行MSSA筛查,研究组患者术前进行常规MSSA和甲氧西林耐药金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA)筛查,并采用莫罗匹星联合洗必泰方案进行去定植。观察两组患者术后SSI发生率,观察研究组患者MSSA和MRSA检出率,以及MSSA筛查和去定植对SSI发生风险的影响。结果对照组SSI发生率为3.81%,研究组为1.36%,两组差异有统计学意义(P<0.05)。研究组共采集鼻拭子样本587份,从101例患者标本中分离出101株金黄色葡萄球菌。101株金黄色葡萄球菌检出MRSA 46例,占45.54%;检出MSSA 55例,占54.46%。Logistic回归分析表明,MSSA筛查和去定植是腰椎后路手术后SSI的保护性因素(OR=0.605,95%CI=0.526~0.760,P=0.006)。结论腰椎手术前筛查MSSA及去定植,可降低患者术后SSI的发生率,值得临床推广应用。Objective To investigate the influence of methicillin sensitive Staphylococcus aureus(MSSA)screening before lumbar surgery on the incidence rate of surgical site infection(SSI).Methods A total of 734 patients with lumbar degenerative diseases who underwent posterior lumbar spine surgery in our hospital from January 2014 to December 2018 were selected as the control group.A total of 587 patients who underwent elective lumbar spine surgery in our hospital from January 2019 to December 2021 were selected as the study group.The control group was not screened for MSSA before surgery,while the patients in the study group were screened for routine MSSA and methicillin-resistant Staphylococcus aureus(MRSA)before surgery.The incidence rate of postoperative SSI in the two groups was observed,the detection rate of MSSA and MRSA in the study group was observed,and the effect of MSSA screening and decolonization on the risk of SSI after balancing confounding factors was observed.Results The incidence rate of SSI was 3.81%in the control group,and that was 1.36%in the study group.There was significant difference between the two groups(P<0.05).A total of 587 nasal swab samples were collected in the study group,and 101 strains of Staphylococcus aureus were isolated from 101 patients.MRSA was detected in 46 cases(45.54%)of 101 strains of Staphylococcus aureus,and MSSA was detected in 55 cases(54.46%).Logistic regression analysis showed that MSSA screening and decolonization are protective factors for SSI after posterior lumbar surgery(OR=0.605,95%CI=0.526-0.760,P=0.006).Conclusion The preoperative screening of MSSA and decolonization can reduce postoperative SSI,which is worthy of clinical application.

关 键 词：腰椎手术 手术部位感染 甲氧西林敏感金黄色葡萄球菌 甲氧西林耐药金黄色葡萄球菌 鼻腔 

分 类 号：R632[医药卫生—外科学]