Risk factors and pathogen analysis of pulmonary infection in acute cervical spinal cord injury

English Keywords:Acute cervical spinal cord injury  Pulmonary infection  Pathogens  Drug-resistant bacteria

English Abstract:

  【Abstract】 Objectives: To investigate the risk factors, pathogen distribution and drug resistance of pulmonary infection secondary to acute cervical spinal cord injury. Methods: From January 2010 to December 2014, 527 patients who suffered from acute cervical spinal cord injury, among them 83 cases complicated with pulmonary infection, were treated. The injury sites(high level: C1-C4; low level: C5-C7), ASIA grade, tracheotomy and mechanical ventilation to pulmonary infection were analyzed by Logistic regression. The sputum culture due to pulmonary infection, the bacterial species, number of isolates and resistance rates were also analyzed. Results: 158 cases(30.0%) were assessed as AISA grade A, among them 43 cases(8.2%) with high lev?鄄el injury received tracheotomy and mechanical ventilation, among them 39 cases(90.7%) suffered from pulmonary infection. Among 115 cases(21.8%) with low level injury, 52 cases received tracheotomy, and 21 cases received mechanical ventilation, among them, 16 case(76.2%) suffered from pulmonary infection, while among 31 cases without mechanical ventilation, 7 cases(22.6%) suffered from pulmonary infection. 103 cases(19.5%) were assessed as ASIA grade B, among 27 cases(5.1%) with high level injury, 19 cases received tracheotomy and mechanical ventilation, among them, 12 cases(63.2%) suffered from pulmonary infection. Among 76 cases(14.4%) with high level injury, 27 cases received tracheotomy, among 18 cases receiving mechanical ventilation, 2 cases(11.1%) suffered from pulmonary infection. No pulmonary infection was noted in 9 cases without mechanical ventilation. 83 cases and 183 cases were assessed as ASIA grade C and D, respectively, no tracheotomy, mechanical ventilation or pulmonary infection was noted. Logistic regression analysis showed that high level injury, ASIA grade A and mechanical ventilation were risk factors for pulmonary infection secondary to acute cervical spinal cord injury. No significant correlation was found between tracheotomy and pulmonary infection(P=0.07). 117 bacteria were cultured from the 83 cases suffering from pulmonary infection, among them, there were 76(65.0%) G-non-fermenting bacteria(P.Aeruginosa, Loffi Acinetobacter, Acinetobacter baumannii, Stenotrophomonas maltophilia, K.ozaenae, Serratia liquefaciens, Phenylketonuria Moraxella and Pseudomonas alcaligenes), in which 59(65.0%) were multi-drug resistant(MDR), 23(13.8%) were Staphylococcus aureus with 7(30.4%) MRSA, 12 were Enterobacter(10.3%) with 5(41.7%) MDR Enterobacter. Conclusions: High level injury, ASIA grade A injury and mechanical ventilation are risk factors for pulmonary infection secondary to acute cervical spinal cord injury, multi-drug resistant G-non-fermenting bacteria are the main pathogens of pulmonary infection, while MRSA and multi-drug resistant enterobacter consists a certain proportion.