骨科手术患者术后医院感染情况与多重耐药菌特征

Clinical characteristics of nosocomial infection and multidrug resistant bacteria in orthopedic patients after surgery

目的探讨骨科手术患者术后医院感染情况与多重耐药菌特征,为该类患者的治疗提供参考。方法回顾性分析2020年1月至2023年1月我院收治的骨科手术患者5034例,共有63例患者发生了术后医院感染,感染率为1.25%。采用VITEK-2 Compact微生物分析仪进行细菌鉴定和药敏试验,药敏试验采用K-B纸片扩散法。比较骨科手术后医院感染患者的感染部位、医院感染病原菌构成、多重耐药菌构成。采用单因素与多因素Logistic回归分析影响骨科患者术后发生医院感染的因素。结果63例术后医院感染患者的感染部位中,手术切口最多,占39.68%(25/63)。63例术后医院感染患者样本中共分离出118株病原菌,其中革兰阳性菌占62.71%(74/118),主要为金黄色葡萄球菌和表皮葡萄球菌;革兰阴性菌占34.75%(41/118),主要为铜绿假单胞菌;真菌占2.54%(3/118)。118株病原菌中多重耐药菌有32株,占27.12%(32/118),均为革兰阴性菌。铜绿假单胞菌对头孢噻肟的耐药率最高,达90.91%;鲍曼不动杆菌对庆大霉素的耐药率最高,达87.50%;大肠埃希菌对头孢噻肟的耐药率最高,达88.89%。单因素分析显示,住院时长、手术时长、糖尿病、泌尿道插管、使用呼吸机和联用抗菌类药物与骨科患者术后医院感染有关(均P<0.05)。多因素Logistic回归分析显示,住院时长≥10 d、手术时长≥2 h、患有糖尿病、有泌尿插管、使用呼吸机、联用抗菌类药物是骨科手术患者术后发生医院感染的危险因素(均P<0.05)。结论骨科手术患者术后医院感染中革兰阳性菌是主要病原菌,多重耐药菌的比例较高,应根据药敏检测结果选择合适的抗生素进行治疗。住院时长、手术时长、糖尿病、泌尿插管、使用呼吸机和联用抗菌类药物都是影响骨科患者术后发生医院感染的危险因素,临床上应进行合理干预,从而减少感染的发生。

Objective To investigate the nosocomial infection and characteristics of multidrug resistant bacteria in orthopedic patients after surgery,providing a reference for the treatment.Methods A retrospective analysis was conducted among 5,034 orthopedic surgery patients admitted to our hospital from January 2020 to January 2023,among whom 63 patients developed postoperative hospital infection,with an infection rate of 1.25%.VITEK-2 Compact microbiological analyzer was used for bacterial identification and drug sensitivity test,and the drug sensitivity test was conducted using K-B disk diffusion method.The infection site,composition of pathogenic bacteria,and the composition of multidrug resistant bacteria in the patients with hospital infection after orthopedic surgery were compared.Univariate and multivariate Logistic regression analyses were applied to analyze the factors influencing the occurrence of hospital infection in orthopedic patients after surgery.Results Among the 63 patients with postoperative hospital infection,surgical incision was the most common infection site,accounting for 39.68%(25/63).A total of 118 strains of pathogenic bacteria were isolated,among which Gram positive bacteria accounted for 62.71%(74/118),mainly Staphylococcus aureus and Staphylococcus epidermidis;Gram negative bacteria accounted for 34.75%(41/118),mainly Pseudomonas aeruginosa,and fungi accounted for 2.54%(3/118).Among the 118 strains of pathogenic bacteria,32 strains(27.12%)were multidrug resistant,all of which were Gram negative.The resistance rate of Pseudomonas aeruginosa to Cefotaxime was the highest,reached 90.91%.The resistance rate of Acinetobacter baumannii to Gentamicin was the highest,reached 87.50%.The resistance rate of Escherichia coli to Cefotaxime was the highest,reached 88.89%.Univariate analysis showed that the length of hospital stay,the length of surgery,diabetes,urinary intubation,use of respirator and combined use of antibiotics were related to postoperative hospital infection in orthopedic patients(all P<0.05).Multivariate Logistic regression analysis showed that the length of hospitalization≥10 days,the length of surgery≥2 hours,diabetes,urinary catheterization,use of respirator and combined use of antibacterial drugs were the risk factors for postoperative hospital infection in orthopedic patients(all P<0.05).Conclusion Gram positive bacteria are the main pathogens in orthopaedic patients with postoperative hospital infection,and the proportion of multidrug resistant bacteria is high.Appropriate antibiotics should be selected according to the drug sensitivity results.The length of hospital stay,length of surgery,diabetes,urinary catheterization,respirator use and combined use of antibiotics are the factors that infect the occurrence of hospital infections in orthopedic patients after surgery.Reasonable clinical intervention should be carried out to reduce the incidence of infection.