老年腰椎骨折术后深部切口感染患者病原菌和感染危险因素分析

分析老年腰椎骨折术后切口深部感染患者的病原菌分布特征及感染危险因素，为该类患者的治疗提供参考。

选择2018年2月至2021年2月于我院行腰椎手术治疗且符合纳入标准的患者589例，记录患者感染发生率，并对感染病原菌分布特征及感染的危险因素进行单因素和多因素分析，同时探讨相应对策。

589例腰椎骨折手术患者有41例（6.96%）出现切口深部感染。41例感染患者的渗出液或分泌物中鉴定分离出53株病原菌，其中30例患者为单菌株感染，占73.17%；11例患者为多菌株感染，占26.83%。53株病原菌中革兰阴性菌30株，革兰阳性菌22株，真菌1株。革兰阴性菌中，大肠埃希菌对哌拉西林的耐药率最高，为91.67%；对美罗培南、亚胺培南及厄他培南的耐药率相对较低，为16.67%；铜绿假单胞菌对头孢吡肟、头孢曲松、头孢唑林和复方磺胺甲噁唑的耐药率最高，为90.00%；对环丙沙星和阿米卡星的耐药率相对较低，为20.00%。革兰阳性菌中金黄色葡萄球菌对青霉素和红霉素的耐药率最高，为76.92%；对万古霉素、利奈唑胺的耐药率为0.00%。术后感染患者与非感染患者在年龄分布、BMI、是否合并糖尿病、手术持续时间、是否输血等方面的差异有统计学意义（均P＜0.05）；在性别、是否存在烟酒史、是否合并高血压或冠心病、术中失血量等方面差异无统计学意义（均P＞0.05）。Logistic回归分析显示，年龄≥60岁、BMI≥28 kg/m²、合并糖尿病、手术时间≥2 h及预防性应用抗生素为腰椎骨折术后患者切口深部感染的独立危险因素（均P＜0.05）。

腰椎骨折术后患者深部切口感染病原菌种类较多，以金黄色葡萄球菌和大肠埃希菌为主，且药敏性普遍较低。年龄≥60岁、BMI≥28 kg/m²、合并糖尿病、手术时间≥2 h及预防性应用抗生素为腰椎骨折术后患者切口深部感染的独立危险因素，临床应根据药敏情况合理选择抗菌药物以降低感染发生率。

Risk factors and pathogen distrbution in elderly patients with deep incision infection after surgery for lumbar spine fracture

Objective To analyze the risk factors and pathogen distrbution in elderly patients with deep incision infection after surgery for lumbar spine fracture, and provide a reference for the treatment. Methods A total of 589 patients who underwent surgery for lumbar spine fracture in our hospital from February 2018 to February 2021 and met the inclusion criteria were enrolled. The probability of infection in the patients was recorded, and the distribution of infectious pathogens, risk factors for infection were subjected to single-factor and multi-factor analyses, while discussing the corresponding countermeasures. Results Forty-one out of the 589 patients (6.96%) who underwent lumbar spine surgery developed deep incision infection. Fifty-three pathogenic bacteria were identified and isolated from the exudates or secretions of the 41 patients. Among them, 30 patients were infected with single strain, accounting for 73.17%, and 11 patients were infected with multiple strains, accounting for 26.83%. Among the 53 strains, 30 Gram-negative bacteria, 22 Gram-positive bacteria, and 1 fungus were identified. Among the Gram-negative bacteria, Escherichia coli had the highest resistance rate to Piperacillin (91.67%), and low resistance rate to Meropenem, Imipenem and Ertapenem (16.67%); Pseudomonas aeruginosa had the highest resistance rate to Cefepime, Ceftriaxone, Cefazolin and compound Sulfamethoxazole (90.00%), and low resistance rate to Ciprofloxacin and Amimi (20.00%). Staphylococcus aureus was the main Gram-positive bacteria after lumbar spine surgery. Its resistance rate to Penicillin and Erythromycin was 76.92%, and that to Vancomycin and Linezolid was 0.00%. There were statistical differences between infected patients and uninfected patients in the age, BMI, diabetes, operation duration and blood transfusion (all P＜0.05); there were no significant differences in gender, history of tobacco and alcohol, concomitant hypertension or coronary heart disease and blood loss (all P＞0.05). Logistic regression analysis showed that age ≥ 60 years, BMI ≥ 28 kg/m2, diabetes mellitus, operation time ≥ 2 h and preventive use of antibiotics were independent risk factors for deep incision infection in patients after lumbar spine surgery (all P＜0.05). Conclusion There are many types of pathogenic bacteria causing deep incision infection after lumbar spine surgery, mainly Staphylococcus aureus and Escherichia coli, and the drug sensitivity is generally low. Age ≥ 60 years, BMI ≥ 28 kg/m2, diabetes mellitus, operation time ≥ 2 h and preventive use of antibiotics are independent risk factors for deep incision infection in patients after surgery for lumbar spine fracture. Clinical antibiotics should be selected based on drug sensitivity to reduce the incidence of infection.