腰椎间盘突出症术后并发椎间隙感染病原菌分布特点及危险因素分析  

Analysis of the distribution characteristics and risk factors of pathogens causing postoperative intervertebral space infection in patients with lumbar disc herniation

作　　者：朱文辉 薛景景 杨炳 张凯 ZHU Wenhui;XUE Jingjing;YANG Bing;ZHANG Kai(Department of Spine Surgery,Sanmenria hospital f traditional Chinese medicine,Sanmenzia 472000,Henan,China)

机构地区：[1]河南省三门峡市中医院脊柱外科,河南三门峡472000

出　　处：《中国病原生物学杂志》2024年第9期1092-1095,共4页Journal of Pathogen Biology

基　　金：三门峡市2022年科技发展计划项目(No.2022002047)。

摘　　要：目的探讨腰椎间盘突出症术后并发椎间隙感染病原菌分布特点及危险因素。方法选取2452例本院行手术治疗的腰椎间盘突出症患者为研究对象,对比不同手术方式患者的感染率,采集患者病变节段组织进行病原学培养,分析椎间隙感染患者病原菌分布特点。以术后是否并发椎间隙感染进行分组,对比两组患者临床资料,分析腰椎间盘突出症术后并发椎间隙感染的危险因素。结果2452例患者中,38例发生术后椎间隙感染,感染率1.55%。1015例行单阶段开窗减压手术,感染率0.59%(6/1015),652例行双多节段开窗减压手术,感染率1.38%(9/652),538例行单节段内固定手术,感染率2.60%(14/538),247例行双多节段内固定手术,感染率3.64%(9/247)。不同手术方式感染率差异有统计学意义(χ^(2)=17.240,P<0.05)。38例感染者检出病原菌43株,革兰阳性菌26株(占60.47%),为革兰阴性菌15株(占34.88%),真菌2株(占4.65%)。革兰阳性菌中,主要为金黄色葡萄球菌(37.21%,16/43)与表皮葡萄球菌(23.26%,10/43),革兰阴性菌中,主要为大肠埃希菌(13.95%,6/43)与阴沟肠杆菌(9.30%,4/43),真菌均为白色假丝酵母菌。革兰阳性菌对青霉素、氨苄西林、红霉素、克林霉素、环丙沙星、庆大霉素、复方新诺明的耐药率高于50%,未产生对万古霉素、替考拉宁、利奈唑胺的耐药株。革兰阴性菌对氨苄西林、环丙沙星、妥布霉素、庆大霉素的耐药率高于50%,对头孢吡肟、亚胺培南、美罗培南、莫西沙星、阿米卡星的敏感性较高。腰椎间盘突出症术后并发椎间隙感染与未感染患者年龄、BMI、合并糖尿病、手术时间、术中出血量、导尿管留置时间、术后合并其他系统感染差异有统计学意义(P<0.05),性别、合并高血压差异无统计学意义(P>0.05)。BMI≥27 kg/m2、合并糖尿病、手术时间≥3 h、术中出血量≥1500 mL、导尿管留置时间≥48 h、术后合并其他系统感染,是Objective The distribution characteristics and risk factors of pathogens causing intervertebral space infection after surgery for lumbar disc herniation were explored.Methods 2452 patients with lumbar disc herniation who underwent surgical treatment in our hospital were selected as the subjects of this study.The infection rates of patients with different surgical methods were compared.The diseased segment tissues were collected from patients for pathogen culture,and the distribution characteristics of pathogens in patients with intervertebral space infection were analyzed.Grouping based on whether there was postoperative intervertebral space infection,comparing clinical data of two groups of patients,the risk factors for postoperative intervertebral space infection in lumbar disc herniation were analyzed.Results Among 2452 patients,38 cases experienced postoperative intervertebral space infection,with an infection rate of 1.55%.1015 cases underwent single-stage fenestration and decompression surgery,with an infection rate of 0.59%(6/1015).652 cases underwent double or multi-segment fenestration and decompression surgery,with an infection rate of 1.38%(9/652).538 cases underwent single-segment internal fixation surgery,with an infection rate of 2.60%(14/538).247 cases underwent double or multi-segment internal fixation surgery,with an infection rate of 3.64%(9/247).There was a statistically significant difference in the postoperative intervertebral space infection rate among patients with surgical methods(χ^(2)=17.240,P<0.05).43 strains of pathogenic bacteria were detected in 38 infected cases.There were 26 strains of Gram-positive bacteria(accounting for 60.47%),15 strains of Gram-negative bacteria(accounting for 34.88%),and 2 strains of fungi(accounting for 4.65%).Among Gram positive bacteria,the main ones were Staphylococcus aureus(37.21%,16/43)and Staphylococcus epidermidis(23.26%,10/43).Among Gram negative bacteria,the main ones were Escherichia coli(13.95%,6/43)and Enterobacter cloacae(9.30%,4/43).The fungi

关 键 词：腰椎间盘突出症 椎间隙感染 病原菌 危险因素 

分 类 号：R687.3[医药卫生—骨科学]