脊柱手术部位病原菌分布及危险因素

　　[摘要] 目的 通过目标性监测探讨脊柱手术部位病原菌分布和耐药性以及手术部位感染的危险因素，为临床合理用药及防治提供依据。方法 回顾性分析随机抽取的2015年5月～2016年12月间816例首次在我院脊柱科就诊的各类疾病患者的病历资料，统计分析手术部位感染患者的病原菌以及耐药性，通过病历资料分析相关的危险因素。将手术部位感染患者中出现诊断时的临床表现和相关实验室炎性指标输入EXCEL软件中，统计阳性率。结果 816例患者脊柱手术部位切口分泌物培养阳性38例，目标性监测术后手术部位中的感染率为4.66%；38例患者分离得到55株病原菌，其中64.82%为革兰阳性菌；革兰阳性菌前三位分别是金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌；35.18%为革兰阴性菌，其中以大肠埃希菌为主，8株占14.55%；未检测出对万古霉素耐药的金黄色葡萄球菌，耐甲氧西林的表皮葡萄球菌的检出率高于金黄色葡萄球菌，革兰阴性菌的耐药性严重；单因素分析显示，年龄、糖尿病、手术时间等6项因素与脊柱手术切口感染的发生有关。进一步多因素回归分析显示糖尿病、手术持續时间≥180 min、住院天数≥15 d与脊柱手术切口感染有关。 结论 脊柱手术切口感染病原菌主要以金黄色葡萄球菌为主，耐药性高，糖尿病、手术持续时间≥180 min、住院天数≥15 d均是感染的独立危险因素。
　　[关键词] 手术部位；目标性监测；病原菌；危险因素
　　[中图分类号] R446.5；R619 [文献标识码] A [文章编号] 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.

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