目的 探究胸腰椎骨折患者术后手术部位感染的病原菌特征及影响因素。方法 选取2022年2月至2025年2月于南充市中医医院行内固定术治疗的胸腰椎骨折患者1 500例为研究对象,根据术后手术部位是否感染分为非感染组（n=1 476）和感染组（n=24）,分析手术部位感染患者病原菌特征并收集患者临床资料分析。结果 24例胸腰椎骨折术后手术部位感染患者病原菌培养分离病原菌28株,革兰氏阳性菌11株,革兰氏阴性菌16株,真菌1株;金黄色葡萄球菌对阿莫西林、氨苄西林、青霉素的耐药率较高,耐药率为60.00%、60.00%、80.00%;表皮葡萄球菌对阿莫西林、氨苄西林、青霉素的耐药率分别为50.00%、50.00%、75.00%;大肠埃希菌对阿莫西林、氨苄西林、哌拉西林、庆大霉素均具有较高耐药率,分别为50.00%、66.67%、83.33%、50.00%;铜绿假单胞菌则对复方磺胺甲噁唑片、阿莫西林、氨苄西林、哌拉西林等具有较高耐药性,分别为60.00%、60.00%、60.00%、80.00%。感染组手术节段数>3、术中出血量>400 mL、术后引流管留置时间>3d的患者占比高于非感染组以及白蛋白（albumin,ALB）水平低于非感染组;手术节段数（r=0.067）、术中出血量（r=0.158）、术后引流管留置时间（r=0.065）与手术部位感染呈正相关,而ALB水平则为负相关（r=-0.056）,仅有术中出血量、术后引流管留置时间以及ALB水平为手术部位感染的独立影响因素,术中出血量具有较好的预测效能（AUC=0.765>0.700）。结论 胸腰椎骨折患者手术部位感染革兰氏阴性菌占比稍高,术中出血量、术后引流管留置时间以及ALB水平为胸腰椎骨折的独立影响因素,术中出血量预测价值佳,可作为手术部位感染早期诊断的潜在生物标志物。
Abstract
Objective To investigate the characteristics of pathogens and influencing factors of surgical site infections (SSI) in patients with thoracolumbar fractures after surgery. Methods A total of 1500 patients with thoracolumbar fractures who underwent internal fixation at Nanchong Hospital of Traditional Chinese Medicine from February 2022 to February 2025 were studied. Patients were divided into non - infection (n=1476) and infection (n=24) groups. Pathogen cultures from SSI patients were analyzed, and clinical data were collected for univariate and multivariate logistic regression analyses. Results Among the 24 patients with SSIs, a total of 28 pathogens were isolated, including 11 Gram-positive bacteria, 16 Gram-negative bacteria, and 1 fungus. The resistance rates of Staphylococcus aureus to amoxicillin, ampicillin, and penicillin were 60.00%, 60.00%, and 80.00%, respectively. The resistance rates of Staphylococcus epidermidis to amoxicillin, ampicillin, and penicillin were 50.00%, 50.00%, and 75.00%, respectively. Escherichia coli exhibited high resistance rates to amoxicillin, ampicillin, piperacillin, and gentamicin, at 50.00%, 66.67%, 83.33%, and 50.00%, respectively. Pseudomonas aeruginosa showed high resistance to co-trimoxazole, amoxicillin, ampicillin, and piperacillin, with resistance rates of 60.00%, 60.00%, 60.00%, and 80.00%, respectively. The infection group had a higher proportion of patients with surgical segments>3, intraoperative blood loss>400 mL, and postoperative drainage tube placement>3 days than the non - infection group. Albumin (ALB) levels were lower in the infection group. Surgical segments, intraoperative blood loss, and postoperative drainage time were positively correlated with SSIs, while ALB levels were negatively correlated. Multivariate analysis revealed intraoperative blood loss, postoperative drainage time, and ALB levels as independent risk factors for SSIs, with intraoperative blood loss showing good predictive value (AUC=0.765>0.700). Conclusion In patients with thoracolumbar fractures, Gram-negative bacteria account for a slightly higher proportion of surgical site infections. Intraoperative blood loss, postoperative drainage time, and ALB levels are independent risk factors for SSIs. Intraoperative blood loss has good predictive value and can serve as a potential biomarker for the early diagnosis of SSI.
关键词
胸腰椎骨折 /
手术 /
感染 /
病原菌 /
危险因素
Key words
thoracolumbar fractures /
surgery /
infection /
pathogens /
risk factors
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基金
四川中医药管理局2024年科研项目“探讨化气祛瘀通幽汤对胸腰椎骨折便秘大鼠肠道微生态调节作用的研究”（2024MS614）; 2025年度南充市社科规划项目川北健康人文研究专项课题：“川北龚氏骨伤科非物质文化遗产的传承与发展研究”（NC25CB01）; 2025年度南充市社科规划项目“南充董氏正骨活血化瘀流派研究”（NC25B010）; 2025年南充市哲学社会科学研究规划项目“名老中医医案研究中心”专项课题“化气祛瘀通幽方改善骨折卧床患者便秘的理论基础及机制研究”（YAZX25-ZD-03）
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