Pathogenic bacteria and local antibiotic treatment of deep surgical site infection after posterior lumbar fusion and internal fixation

HAN Zhi-hong; WEN Cun-ning; PANG Shuo; XIONG Shang-wen; XIE Dong-yan

doi:10.11659/jjssx.11E022032

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Pathogenic bacteria and local antibiotic treatment of deep surgical site infection after posterior lumbar fusion and internal fixation

Clinical Research | 更新时间：2023-11-24

- Pathogenic bacteria and local antibiotic treatment of deep surgical site infection after posterior lumbar fusion and internal fixation
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 32, Issue 11, Pages: 1017-1020(2023)
- 作者机构：
  
  1.邯郸市第一医院脊柱骨肿瘤科，河北邯郸 056001
  2.邯郸市第一医院急诊科，河北邯郸 056001
  3.邯郸市第一医院神经介入外科，河北邯郸 056001
  4.邯郸市第一医院东区综合外科，河北邯郸 056001
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.11E022032
  CLC： R633
- Published：25 November 2023，
  
  Received：08 November 2022，
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韩志红,温存宁,庞硕等.腰椎后路融合内固定术后切口深部感染病原菌及局部抗菌药物治疗研究[J].局解手术学杂志,2023,32(11):1017-1020.

HAN Zhi-hong,WEN Cun-ning,PANG Shuo,et al.Pathogenic bacteria and local antibiotic treatment of deep surgical site infection after posterior lumbar fusion and internal fixation[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(11):1017-1020.
韩志红,温存宁,庞硕等.腰椎后路融合内固定术后切口深部感染病原菌及局部抗菌药物治疗研究[J].局解手术学杂志,2023,32(11):1017-1020. DOI： 10.11659/jjssx.11E022032.

HAN Zhi-hong,WEN Cun-ning,PANG Shuo,et al.Pathogenic bacteria and local antibiotic treatment of deep surgical site infection after posterior lumbar fusion and internal fixation[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2023,32(11):1017-1020. DOI： 10.11659/jjssx.11E022032.

摘要

目的

探讨腰椎后路融合内固定术后早期切口深部感染病原菌分布特征及局部应用抗菌药物的疗效。

方法

前瞻性选取2020年5月至2022年5月于我院行腰椎后路融合内固定术后并发早期感染的60例患者，收集患者感染部位分泌物进行细菌培养，分析病原菌分布特征及主要病原菌耐药性。将患者随机分为对照组和观察组，观察组（30例）采用清创联合抗菌药物局部持续灌注引流治疗，对照组（30例）采用清创联合灌注等量生理盐水治疗，对比2组治疗效果。

结果

60例样本中检出病原菌90株，其中革兰氏阳性菌30株（33.33%），以金黄色葡萄球菌（20.00%）为主要致病菌；革兰氏阴性菌56株（62.22%），以铜绿假单胞菌（28.89%）为主要致病菌；真菌4株（4.44%）。革兰氏阴性菌中，铜绿假单胞菌对庆大霉素、环丙沙星及氨苄西林耐药性较高，大肠埃希菌对头孢唑林耐药性较高，肺炎克雷伯菌对庆大霉素耐药性较高。革兰氏阳性菌中，金黄色葡萄球菌对氨苄西林和青霉素耐药性较高，表皮葡萄球菌对万古霉素耐药性较高，凝固酶阴性葡萄球菌对氨苄西林、红霉素耐药性较高。2组患者治疗后VAS评分、ODI显著降低（

0.05）；体温及WBC、CRP、PCT、ESR水平均明显改善（

0.05），且观察组改善情况优于对照组。与对照组比较，观察组患者灌注引流时间、引流管放置时间、静脉使用抗菌药物时间及住院时间均明显缩短（

0.05），但2组患者切口愈合时间无显著差异（

0.05）。

结论

腰椎后路融合内固定术后早期切口深部感染多以金黄色葡萄球菌及铜绿假单胞菌为主，清创联合抗菌药物局部持续灌注引流治疗感染疗效可靠。

Abstract

Objective

To investigate the distribution characteristics of pathogenic bacteria in early deep surgical site infection after posterior lumbar fusion and internal fixation and the effect of local antibiotic treatment.

Methods

A total of 60 patients with early infection after posterior lumbar fusion and internal fixation in our hospital from May 2020 to May 2022 were prospectively selected. The secretions of the infected site of patients were collected for bacterial culture， and the distribution characteristic of pathogenic bacteria and the drug resistance of main pathogenic bacteria were analyzed. The patients were randomly divided into the control group and the observation group. The observation group （30 cases） was treated with debridement combined with antibiotics local continuous perfusion and drainage， while the control group （30 cases）was treated with debridement combined with perfusion of equal amount of normal saline.The treatment effects of the two groups were compared.

Results

A total of 90 strains of pathogenic bacteria were detected in 60 samples， including 30 strains （33.33%）of Gram-positive bacteria， of which Staphylococcus aureus was the main pathogenic bacteria （20.00%）； there were 56 strains （62.22%） of Gram-negative bacteria， of which Pseudomonas aeruginosa was the main pathogenic bacteria （28.89%）； 4 strains （4.44%） of fungi. Among gram-negative bacteria

Pseudomonas aeruginosa was highly resistant to gentamicin

ciprofloxacin and ampicillin

Escherichia coli was highly resistant to cefazolin

and Klebsiella pneumoniae was highly resistant to gentamicin. Among gram-positive bacteria

Staphylococcus aureus was highly resistant to ampicillin and penicillin

Staphylococcus epidermidis was highly resistant to vancomycin

and Coagulase-negative staphylococcus was highly resistant to ampicillin and erythromycin. After treatment， the VAS score and ODI of patients in the two groups decreased significantly（

0.05）， and the body temperature， WBC， CRP， PCT and ESR were significantly improved （

0.05）， and the improvements in the observation group were better than those in the control group. Compared with the control group， the perfusion drainage time， drainage tube placement time， intravenous antibiotic use time and hospitalization time of patients in the observation group were significantly shortened （

0.05）； but there was no significant difference in the wound healing time between the two groups （

0.05）.

Conclusion

Staphylococcus aureus and Pseudomonas aeruginosa are the main pathogenic bacteria in early deep surgical site infection after posterior lumbar fusion and internal fixation， and debridement combined with antibiotics local continuous perfusion and drainage have a reliable effect on infection.

关键词

腰椎后路融合内固定术切口感染病原菌耐药性抗菌药物清创

Keywords

posterior lumbar fusion and internal fixationsurgical site infectionpathogenic bacteriadrug resistanceantibioticsdebridement

references

唐伟，马良，地里下提·阿不力孜.前路病灶清除、植骨融合加后路内固定术治疗胸腰椎结核患者疗效及对围术期指标和神经功能恢复的影响［J］.湖南师范大学学报（医学版），2022，19（4）：50-54.doi：10.3969/j.issn.1673-016X.2022.04.013http://dx.doi.org/10.3969/j.issn.1673-016X.2022.04.013.

Gao Q，Han C，Romani MD，et al.Posterior-only debridement，internalfixation，and interbody fusion using titanium mesh in the surgical treatment of thoracolumbar tuberculosis with spinal epidural abscess：a minimum 5-year follow-up［J］.BMC Musculoskelet Disord，2021，22（1）：917.doi：10.1186/s12891-021-04797-2http://dx.doi.org/10.1186/s12891-021-04797-2.

Li Z，He M，Chen X，et al.Single-stage posterior resection of the transversal process combined with an intervertebral foraminal approach for debridement，interbodyfusion，internal fixation for the treatment of lumbar tuberculosis and psoas major abscess［J］.Int Orthop，2022 ，46（2）：331-339.doi：10.1007/s00264-021-05244-6http://dx.doi.org/10.1007/s00264-021-05244-6.

朱禧，吴昊，施建党，等.清创联合抗生素溶液局部持续灌注引流治疗胸腰椎后路内固定术后早期切口深部感染的疗效观察［J］.中国脊柱脊髓杂志，2021，31（4）：365-369.doi：10.3969/j.issn.1004-406X.2021.04.13http://dx.doi.org/10.3969/j.issn.1004-406X.2021.04.13.

Obolski U，Stein GY，Hadany L.Antibiotic restriction might facilitate the emergence of multi-drug resistance［J］.PLoS Comput Biol，2015，11（6）：e1004340.doi：10.1371/journal.pcbi.1004340http://dx.doi.org/10.1371/journal.pcbi.1004340.

覃康，张世民，姚喜州，等.局部措施预防骨科手术部位感染研究进展［J］.国际骨科学杂志，2018，39（6）：340-343.doi：10.3969/j.issn.1673-7083.2018.06.002http://dx.doi.org/10.3969/j.issn.1673-7083.2018.06.002.

王玲娟，刘艳武，董婷婷，等.老年胸腰椎骨折术后早期切口感染病原菌情况及危险因素分析［J］.河北医药，2020，42（16）：2493-2496.doi：10.3969/j.issn.1002-7386.2020.16.022http://dx.doi.org/10.3969/j.issn.1002-7386.2020.16.022.

刘斌，甘维，王华富，等.腰椎后路融合内固定术后感染的多因素logistic回归分析［J］.临床骨科杂志，2020，23（6）：788-791.doi：10.3969/j.issn.1008-0287.2020.06.011http://dx.doi.org/10.3969/j.issn.1008-0287.2020.06.011.

宇洪浩，原泉，王欢.胸腰椎后路内固定术后早期切口感染的影响因素［J］.中国医科大学学报，2019，48（5）：406-409.doi：10.12007/j.issn.0258-4646.2019.05.006http://dx.doi.org/10.12007/j.issn.0258-4646.2019.05.006.

阮狄克，李海峰，石磊.脊柱手术部位感染的早期诊断治疗与危险因素分析［J］.中国骨伤，2019，32（10）：879-881.doi：10.3969/j.issn.1003-0034.2019.10.001http://dx.doi.org/10.3969/j.issn.1003-0034.2019.10.001.

向渝，刘明永，殷翔，等.腰椎退行性疾病行后路内固定融合术后早期感染清创的危险因素分析［J］.局解手术学杂志，2021，30（2）：108-113.doi：10.11659/jjssx.10E020032http://dx.doi.org/10.11659/jjssx.10E020032.

江共群，刘永恒，陈德元，等.脊柱后路固定术后近端交界区迟发性感染分析与治疗探讨［J］.中国骨伤，2018，31（4）：368-372.doi：10.3969/j.issn.1003-0034.2018.04.013http://dx.doi.org/10.3969/j.issn.1003-0034.2018.04.013.

赵兵，黄海锋，尹振宇，等.腰椎间盘突出症术后椎间隙感染病原菌分布及影响因素分析［J］.河北医学，2021，27（4）：620-625.doi：10.3969/j.issn.1006-6233.2021.04.020http://dx.doi.org/10.3969/j.issn.1006-6233.2021.04.020.

朱新峰，李晓霜.胸腰椎后路椎弓根钉内固定术后迟发性感染病原菌分布及耐药性分析［J］.中国骨与关节损伤杂志，2020，35（5）：510-512.doi：10.7531/j.issn.1672-9935.2020.05.021http://dx.doi.org/10.7531/j.issn.1672-9935.2020.05.021.

苏新磊，李爱霞，张桂莲，等.脊柱内固定术后早期切口深部感染的诊治探讨［J］.生物骨科材料与临床研究，2019，16（3）：39-43.doi：10.3969/j.issn.1672-5972.2019.03.008http://dx.doi.org/10.3969/j.issn.1672-5972.2019.03.008.

Maria S，Deyanira C，Francesca S，et al.Spinal fusion surgery and local antibiotic administration：a systematic review on key points from preclinical and clinical data［J］.Spine （Phila Pa 1976），2020，45（5）：339-348.doi：10.1097/BRS.0000000000003255http://dx.doi.org/10.1097/BRS.0000000000003255.

Zhou J，Wang R，Huo X，et al.Incidence of surgical site infection after spine surgery：a systematic review and meta-analysis［J］.Spine （Phila Pa 1976），2020 ，45（3）：208-216.doi：10.1097/BRS. 0000000000003218http://dx.doi.org/10.1097/BRS.0000000000003218.

Urquhart JC，Collings D，Nutt L，et al.The effect of prolonged postoperative antibiotic administration on the rate of infection in patients undergoing posterior spinal surgery requiring a closed-suction drain：a randomized controlled trial［J］.J Bone Joint Surg Am，2019，101（19）：1732-1740.doi：10.2106/JBJS.19.00009http://dx.doi.org/10.2106/JBJS.19.00009.

Farah K，Lubiato A，Meyer M，et al.Surgical site infection following surgery for spinal deformity：about 102 patients［J］.Neurochirurgie，2021，67（2）：152-156.doi：10.1016/j.neuchi.2020.10.006http://dx.doi.org/10.1016/j.neuchi.2020.10.006.

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