摘要
目的：分析脊柱后路手术后早期切口感染的病原菌，观察不同处理方法治疗并发症的临床效果。方法回顾性分析30例脊柱后路手术早期切口感染患者，其中表浅感染7例，深部感染23例，分析患者的临床表现、诊断、治疗、病原学、药敏试验及随访结果。结果30例患者感染时间为术后2～15 d，共分离出菌株33株，其中革兰阳性球菌18株（54.5%），以金黄色葡萄球菌多见（13株，39.4%）；革兰阴性杆菌15株（45.5%），以大肠杆菌居多（6株，18.2%）。药敏试验提示革兰阳性球菌对万古霉素、利福平、替考拉宁、复方新诺明敏感性高，未发现对万古霉素耐药的金黄色葡萄球菌；革兰阴性菌对亚胺培南敏感性较高（100%）。7例表浅感染者经换药后治愈；23例深部感染者经伤口彻底清创，置管冲洗引流，且均保留内固定，亦未见感染复发。结论脊柱后路术后早期切口感染病原菌多为金黄色葡萄球菌，对于深部感染者，应早期扩创、持续灌注冲洗引流并使用万古霉素。
Objective To investigate incision pathogenic bacteria after spinal surgery, and observe clinical effects of therapeutic methods. Methods A total of 30 cases of early surgical incision infection （7 cases of superficial infection and 23 cases of deep infection） after spinal surgery were retrospectively analyzed. The basic data including clinical manifes-tations, diagnosis, treatment, etiology and follow-up results were analyzed. Results It was found that the mean infection time after operation was 2-15 days in 30 patients. Thirty-three strains were isolated including 18 gram-positive cocci （54.5%, and Staphylococcus aureus account for 13, 39.4%）, 15 gram-negative bacteria （45.5%, and Coli communior account for 6, 18.2%）. The drug susceptibility test showed that gram-positive cocci were highly sensitive to vancomycin, rifampin, tei-coplanin and cotrimoxazole. No vancomycin-resistant Staphylococcus aureus were found. Gram negative bacteria were high-ly sensitive to imipenem （100%）. Seven cases of superficial infection were cured after dressing. Twenty-three cases of deep incision wound infection were no recurrence of infection after treatment by deep wound debridement, and postoperative cathe-terization. Conclusion The early wound infection after spinal surgery is usually due to Staphylococcus aureus. It is good to perform wound debridement, continuous perfusion drainage, and treatment with vancomycin for deep wound infection.
出处
《天津医药》
CAS
北大核心
2014年第9期915-917,共3页
Tianjin Medical Journal
关键词
脊柱
伤口感染
细菌学
spine
wound infection
bacteriology
