玉米剥皮机伤术后MDROs感染病原菌基因型及危险因素

Genotypes of pathogenic bacteria and risk factors for postoperative MDROs infection in patients with injury caused by corn husker

目的分析医院玉米剥皮机伤患者术后多药耐药菌(MDROs)感染的病原菌基因型及MDROs感染的危险因素。方法回顾性分析2015年1月-2020年1月在衡水市人民医院手足外科就诊的玉米剥皮机伤患者的耐药菌株检测结果,Logistic回归分析玉米剥皮机伤患者医院术后MDROs感染的危险因素。结果96例MDROs感染患者中共分离MDROs菌株96株及其他菌株217株;其中耐甲氧西林金黄色葡萄球菌(MRSA)占72.92%,耐万古霉素的肠球菌占27.08%;MRSA、耐万古霉素的肠球菌合并其他菌株中均以铜绿假单胞菌检出率最高;70株MRSA菌株spa分型、多位点序列分型技术(MLST)分型、MLST-spa分型克隆分型分别检出20种spa分型、11种ST分型、28种MLST-spa分型克隆分型,以t002、ST764、ST764-t002检出率最高;耐万古霉素肠球菌中21株为vanA型,5株为vanB表型-vanA基因型;Logistic回归分析显示糖尿病、神经断裂、肌腱断裂、主要血管断裂、掌(指)骨骨折、皮瓣修复、住院天数、抗菌药物使用种类、血糖均是玉米剥皮机伤患者术后医院MDROs感染的独立影响因素。结论医院玉米剥皮机伤患者MDROs感染病原菌基因型存在一定特征,且此类患者MDROs感染的影响因素繁杂,应引起临床重视。

OBJECTIVE To analyze the genotypes of pathogenic bacteria and risk factors for postoperative multidrug-resistant organisms(MDROs)infection in patients with injury caused by corn husker in hospital.METHODS The results of detection of drug-resistant strains in patients with injury caused by corn husker treated in the department of Hand and Foot Surgery at Hengshui People′s Hospital from Jan 2015 to Jan 2020 were retrospectively analyzed.Logistic regression analysis was used to analyze the risk factors for postoperative MDROs infection in patients with injury caused by corn husker was performed.RESULTS A total of 96 MDROs strains and 217 other strains were isolated from 96 patients with MDROs infection.Among them,the proportions of methicillin-resistant Staphylococcus aureus(MRSA)and vancomycin-resistant Enterococcus were 72.92%and 27.08%,respectively.The detection rate of Pseudomonas aeruginosa was the highest among MRSA and vancomycin-resistant Enterococcus combined with other strains.Among 70 MRSA strains,20 spa types,11 ST types,and 28 MLST-spa cloning types were detected in strains of spa typing,MLST typing,and MLST-spa cloning typing,respectively.The detection rates of t002,ST764 and ST764-t002 were the highest.Among vancomycin-resistant Enterococci,21 strains were the vanA type,and 5 strains were the vanB phenotype-vanA genotype.Multivariate Logistic regression analysis showed that diabetes,neurotmesis,tendon rupture,major blood vessel breaks,palm(finger)bone fracture,skin flap repair,hospital stay,types of antibacterial drugs used and blood glucose were independent influencing factors for postoperative MDROs infection in patients with injury caused by corn husker.CONCLUSION Genotypes of pathogenic bacteria causing MDROs infection in patients with injury caused by corn husker in hospital are characteristic,and the influencing factors for MDROs infection are complex in those patients,which needs to be paid more attention.