脊柱手術(shù)部位病原菌分布及危險(xiǎn)因素

　　[摘要] 目的 通過(guò)目標(biāo)性監(jiān)測(cè)探討脊柱手術(shù)部位病原菌分布和耐藥性以及手術(shù)部位感染的危險(xiǎn)因素，為臨床合理用藥及防治提供依據(jù)。方法 回顧性分析隨機(jī)抽取的2015年5月～2016年12月間816例首次在我院脊柱科就診的各類(lèi)疾病患者的病歷資料，統(tǒng)計(jì)分析手術(shù)部位感染患者的病原菌以及耐藥性，通過(guò)病歷資料分析相關(guān)的危險(xiǎn)因素。將手術(shù)部位感染患者中出現(xiàn)診斷時(shí)的臨床表現(xiàn)和相關(guān)實(shí)驗(yàn)室炎性指標(biāo)輸入EXCEL軟件中，統(tǒng)計(jì)陽(yáng)性率。結(jié)果 816例患者脊柱手術(shù)部位切口分泌物培養(yǎng)陽(yáng)性38例，目標(biāo)性監(jiān)測(cè)術(shù)后手術(shù)部位中的感染率為4.66%；38例患者分離得到55株病原菌，其中64.82%為革蘭陽(yáng)性菌；革蘭陽(yáng)性菌前三位分別是金黃色葡萄球菌、表皮葡萄球菌、糞腸球菌；35.18%為革蘭陰性菌，其中以大腸埃希菌為主，8株占14.55%；未檢測(cè)出對(duì)萬(wàn)古霉素耐藥的金黃色葡萄球菌，耐甲氧西林的表皮葡萄球菌的檢出率高于金黃色葡萄球菌，革蘭陰性菌的耐藥性嚴(yán)重；單因素分析顯示，年齡、糖尿病、手術(shù)時(shí)間等6項(xiàng)因素與脊柱手術(shù)切口感染的發(fā)生有關(guān)。進(jìn)一步多因素回歸分析顯示糖尿病、手術(shù)持續(xù)時(shí)間≥180 min、住院天數(shù)≥15 d與脊柱手術(shù)切口感染有關(guān)。 結(jié)論 脊柱手術(shù)切口感染病原菌主要以金黃色葡萄球菌為主，耐藥性高，糖尿病、手術(shù)持續(xù)時(shí)間≥180 min、住院天數(shù)≥15 d均是感染的獨(dú)立危險(xiǎn)因素。
　　[關(guān)鍵詞] 手術(shù)部位；目標(biāo)性監(jiān)測(cè)；病原菌；危險(xiǎn)因素
　　[中圖分類(lèi)號(hào)] R446.5；R619 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-9701（2018）08-0023-05
　　Pathogen distribution and risk factors in spine surgical site
　　SUN Jingxi SUN Yongning WANG Fubin CHEN Jianming
　　Department of Critical Care Medicine， Ningbo Sixth Hospital， Ningbo 315040，China
　　[Abstract] Objective To investigate the distribution and drug resistance of pathogen and the risk factors of infection in spine surgical site through targeted surveillance， so as to provide basis for rational drug use and prevention in clinical work. Methods Retrospective analysis were conducted on medical records of 816 patients. They were randomly selected from patients with spine diseases who were admitted in our hospital for the first time from May 2015 to December 2016. Pathogen and drug resistance in patients with surgical site infection， and related risk factors from medical records were statistically analyzed. The clinical manifestations at diagnosis and related laboratory inflammatory markers in patients with surgical site infection were imported into the EXCEL software and the positive rates were calculated. Results Among 816 cases， 38 cases were positive of incisional secretions in spine surgery. The infection rate in the surgical site was 4.66% after surgery according to targeted surveillance. 55 strains of pathogens were isolated from the 38 positive cases， of which 64.82% were Gram-positive bacteria with Staphylococcus aureus， Staphylococcus epidermidis and Enterococcus faecalis being the first three strains. 35.18% were Gram-negative bacteria， of which Escherichia coli was the main species with 8 strains accounting for 14.55%. No vancomycin-resistant Staphylococcus aureus was detected. The detection rate of methicillin-resistant Staphylococcus epidermidis was higher than that of Staphylococcus aureus. The drug resistance of Gram-negative bacteria was serious. Univariate analysis showed that six factors including age， diabetes， operation time and others were associated with the incidence of incisional infection. Further multivariate regression analysis showed that diabetes， surgical duration≥180 min， hospital stay≥15 d were associated with surgical incision infection. Conclusion Staphylococcus aureus is the main pathogen in spine incisional infection. The high drug resistance， diabetes mellitus， duration of operation≥180 min and hospital stay≥15 d are the independent risk factors of infection.

相關(guān)熱詞搜索：病原菌 脊柱 部位 分布 手術(shù)