骨折患者医院感染临床特征和风险因素分析

Clinical features and risk factors in fracture patients in the hospital

目的了解基层医院内骨折患者感染情况,探讨骨科住院患者医院感染的相关因素,从而降低感染率。方法于2009-2010年共收集骨折患者719例,进行细菌培养鉴定,并对检出的病原菌按照K-B法进行药敏试验,同时收集患者的一般信息。结果骨折患者719例中发生医院感染56例,感染率为7.79%。其中革兰阳性球菌23株(41.07%),主要包括金黄色葡萄球菌、表皮葡萄球菌、肠球菌等;革兰阴性杆菌33株(58.93%),主要包括大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌等。药敏结果显示革兰阳性菌和阴性菌均对青霉素类抗生素耐药率较高。万古霉素和亚胺培南分别是革兰阳性球菌和革兰阴性杆菌敏感性较高的抗菌药物。骨科感染的发生与骨折类型、住院时间、年龄、围手术期抗菌药物使用以及是否有基础疾病有明显关系(P<0.05)。结论骨折患者感染与多种因素相关,应采取积极有效的措施以及合理应用抗生素药物,从而降低骨科患者感染的发生。

Objective To investigate the clinical features and risk factors of the infection in the fracture patients in the primary hospital. Methods Information from 719 fracture patients （2009-2010） were collected. The bacteria identification, drug susceptibility analysis and resistance detection were performed by the K-B method. Results 56 patients （7.79%） were found to have infection. 23 （41.07%） patients had the infection by Gram-positive bacteria （e.g Staphylococcus aureus, Staphylococcus epidermidis and intestinal coccus） and 33 （58.93%） patients had Gram-negative bacterial infection （e.g. Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumonnii）. Both Gram-negative and Gram- positive bacteria were found to have resistance to penicillin. The Gram-positive and Gram-negative bacteria are sensitive to Vancomycin and Imipenem, respectively. There was a significant correlation between orthopedic infections and the fracture type, length of stay, and age of the patients. Conclusions There are many factors affecting the infection of the fracture patients. Taking positive and effective measures and using antibiotics may reduce the infection rate.