后路脊柱术后切口感染病原菌特征及不同治疗方案的疗效观察

目的:探讨后路脊柱术后切口感染病原菌分布特征及不同治疗方案的治疗效果,为临床治疗提供参考。方法:选择32例2015年8月-2019年12月于我院进行后路脊柱术治疗且术后切口出现感染的患者,对其标本进行细菌分离培养鉴定,分析病原菌分布情况并测定细菌药敏性。对浅层切口感染患者采用常规换药治疗,而深部感染者在早期进行扩创冲洗引流,并根据药敏结果选用抗生素治疗,观察不同治疗方案的治疗效果。结果:32例术后切口感染患者中,共检出36株病原菌,革兰阴性菌17株,占47.22%,革兰阳性菌19株,占52.78%。前四位病原菌分别为金黄色葡萄球菌、大肠埃希菌、铜绿假单胞菌、溶血葡萄球菌。大肠埃希菌及铜绿假单胞菌对亚胺培南全部敏感,耐药率为0.00%;黄色葡萄球菌及溶血葡萄球菌对万古霉素、替考拉宁全部敏感,耐药率均为0.00%。浅层切口感染及深部切口感染患者全部治愈,所有患者愈后均随访3个月,未见复发感染病例。结论:后路脊柱术后切口感染以金黄色葡萄球菌为主,临床应对深部切口感染患者行早期行扩创冲洗引流,并根据耐药性结果合理选用抗生素。

Characteristics of Incision Infection Pathogenic Bacteria in Patients after Posterior Spinal Surgery and the Effect of Different Treatment Schemes

ABSTRACT Objective: To explore the characteristics of incision infection pathogenic bacteria in patients after posterior spinal surgery and and the effect of different treatment schemes, in order to provide the reference for clinical treatment. Methods: 32 cases of patients complicated with incision infection after posterior spinal surgery in our hospital from August 2015 to December 2019 were selected and their biological specimens were collected to make isolated culture, then the distribution of pathogenic bacteria was analyzed and the drugs sensitivity were tested. The patients with superficial incision infection were treated with routine dressing change, while those with deep infection were treated with irrigation and drainage in early stage, and antibiotics were selected for treatment according to the drug sensitivity results, then observed the therapeutic effect of different treatment schemes. Results: A total of 36 strains of pathogenic bacteria were detected, including 17 strais of gram negative bacteria(47.22%),19 strains of gram positive bacteria(52.78%), and the top four pathogenic bacterias were staphylococcus aureus, escherichia coli, pseudomonas aeruginosa and staphylococcus haemolyticus.Escherichia coli and Pseudomonas aeruginosa were fully sensitive to imipenem, the drug resistance rates were 0.00%, and Staphylococcus aureus and staphylococcus haemolyticus were fully sensitive to vancomycin, teicoplanin, the drug resistances rate were 0.00%. All the patients with superficial incision infection and deep incision infection were cured. All the patients were followed up for 3 months, and no recurrent infection was found. Conclusion: Staphylococcus aureus is the main pathogenic bacteria causing incision infection in patients after posterior spinal surgery, and the effect is exact when perform the debridement, flushing and drainage combined with antibiotics according to the drug sensitivity test results for patients with deep infection in the early stage. Staphylococcus aureus was the main cause of incision infection after posterior spine surgery. Patients with deep incision infection should be treated with early irrigation and drainage, and antibiotics should be selected reasonably according to the results of drug resistance.