胫骨骨折术后隐性感染患者病原菌检测及感染因素分析

Pathogen detection and infection factor analysis of 80patients of recessive infections after tibia fracture surgery

目的分析胫骨骨折术后隐性感染者病原菌检测及感染因素,对病原菌及导致发生感染的关键因素与减少术后感染的发生提供可靠依据。方法对2007年1月-2012年12月骨外科收治的341例胫骨骨折手术患者资料进行回顾性分析,有80例患者发生术后隐性感染,对其进行病原菌检测;并对导致该类感染的差异有统计学意义的影响因素,进行非条件logistic回归分析,寻找导致感染的影响因素中的独立危险因素。结果共检测出病原菌45株,检出金黄色葡萄球菌、表皮葡萄球菌、痤疮丙酸杆菌、类白喉杆菌、凝固酶阴性葡萄球菌分别占37.78%、26.67%、15.56%、13.33%、6.67%;经logistic回归分析后显示,术后使用高效广谱抗菌药物(β=1.648,OR=4.982)、细菌数量少(β=1.905,OR=6.338)、局部解剖特点(β=1.791,OR=5.676)是导致胫骨骨折术后患者发生隐性感染,影响骨折内固定术治疗效果的危险因素。结论胫骨骨折术后隐性感染不容忽视,应加大对患者手术部位的密切观察,做到发现隐性感染及时治疗,确保患者就医安全。

OBJECTIVE To provide reliable basis for the key factors that pathogens causeing infections and reducingthe incidence of postoperative infections through the pathogen detection and infection factors analysis of patientswith recessive infections after tibia fracture surgery. METHODS A retrospective analysis of the data of 341 patients of orthopedic surgery of tibia fracture admitted in the bone surgery department from Jan 2007 to Dec 2012was performed. 80 patients with recessive infection after tibia fracture surgery were subjected to detection ofpathogens; then a non-conditional logistic regression analysis of the influencing factors with significant differencewas carried out to find out the independent risk factors for infections. RESULTS A total of 45 pathogens were de-tected ,and the results showed that, the Staphylococcus aureus,Staphylococcus epidermidis,Propionibacteriumacnes, diphtheroids, and coagulase-negative Staphylococci accounted for 37. 78%, 26. 67% , 15. 56%, 13. 33%,and 6. 67% respectively; the logistic regression analysis revealed that the use of broad-spectrum antibiotics aftersurgery （β= 1. 648,OR = 4. 982）,less bacteria and weak pathogenicity （β= 1. 905 , OR = 6. 338）, and local ana-tomical characteristics （β=1. 791 ,OR= 5. 676） were the risk factors for the recessive infection after tibia fracturesurgery and affected the therapeutic effect of fracture fixation. CONCLUSION Recessive infection after tibia fracturesurgery should not be ignored. It is necessary to strengthen the close observation on the patients＇ operation sites to findthe recessive infections and treat it in a timely manner so as to ensure the safety of patients in treatment.