ABSTRACT
Objective:To explore the correlation between hepatitis B virus (HBV) infection and deep infection after spinal internal fixation surgery and analysis of pathogenic bacteria.Methods:One hundred and eighty-four patients who underwent spinal internal fixation with HBV infection in Xiaogan First People′s Hospital of Hubei Province from January 2013 to January 2019 were selected as the HBV infection group, and 184 patients who underwent spinal internal fixation with non-HBV infection were selected as the non-HBV infection group. The incidence of deep infection and the distribution of pathogenic bacteria were compared between 2 groups. The influencing factors of postoperative deep infection and HBV reactivation in patients with HBV infection were analyzed by single factor analysis and multi-factor Logistics regression analysis.Results:The incidence of deep infection after spinal internal fixation surgery in HBV infection group was significantly higher than that in non-HBV infection group: 19.57% (36/184) vs. 9.24% (17/184), and there was statistical difference ( P<0.01). The pathogenic bacteria of deep infection in both groups were mainly acinetobacter bausinensis, klebsiella pneumoniae, staphylococcus aureus, staphylococcus epidermidis. There was no statistically significant difference in the distribution of pathogenic bacteria between 2 groups ( P>0.05). The deep infection incidences in age ≥ 65 years, operation time ≥ 3 h, intraoperative blood loss ≥ 1000 ml, CD 4+/CD 8+<1.4, total lymphocyte count<0.7 × 10 9/L, liver function abnormalities (AST>40 U/L or ALT>50 U/L), HBV-DNA (+) patients with HBV infection were significantly higher: 27.16%(22/81) vs. 13.59%(14/103), 28.77%(21/73) vs. 13.51%(15/111), 31.15%(19/61) vs. 13.82%(17/123), 29.69%(19/64) vs. 14.17%(17/120), 27.78% (20/72) vs. 14.29%(16/112), 7/18 vs. 17.47%(29/166), 30.43%(21/69) vs. 13.04%(15/115), and there were statistical differences ( P<0.05 or <0.01). Multivariate Logistic regression analysis showed that intraoperative blood loss (≥ 1 000 ml), CD 4+/CD 8+(<1.4), total lymphocyte count (<0.7 × 10 9/L), and HBV-DNA (+) were independent risk factors for deep infection after spinal internal fixation in patients with HBV infection ( P<0.01 or <0.05). The HBV reactivation incidence in age ≥ 65 years, operation time ≥ 3 h, intraoperative blood loss ≥ 1 000 ml, liver function abnormalities, HBV-DNA (+), postoperative deep infection patients with HBV infection were significantly increased: 33.33% (27/81) vs. 18.45% (19/103), 34.25% (25/73) vs. 18.92% (21/111), 34.43% (21/61) vs. 20.33% (25/123), 8/18 vs. 22.89% (38/166), 34.78% (24/69) vs. 19.13% (22/115), 41.67% (15/36) vs. 20.95% (31/148), and there were statistical differences ( P<0.05). Multivariate Logistic regression analysis showed that intraoperative blood loss (≥ 1 000 ml), HBV-DNA (+) and postoperative deep infection were independent risk factors for HBV reactivation after spinal internal fixation in patients with HBV infection ( P<0.05 or <0.01). Conclusions:HBV infection significantly increases the incidence of deep infection after spinal internal fixation surgery, and the independent risk factors are intraoperative blood loss (≥1 000 ml), CD 4+/CD 8+ (<1.4), total lymphocyte count (<0.7 × 10 9/L), and HBV-DNA (+). Spinal internal fixation surgery can cause HBV reactivation, and its independent risk factors are intraoperative blood loss (≥ 1 000 ml), HBV-DNA (+) and postoperative deep infection.