开放性骨折患者术后感染病原菌分布及耐药性分析

Distribution and drug resistance detection of pathogens for postoperative wound infection of open fracture

目的探讨开放性骨折术后感染常见病原菌分布及耐药性,为降低开放性骨折术后的感染提供依据。方法选取2011年1月-2014年1月收治的62例开放性骨折患者为研究对象,观察患者术后发生感染病原菌分布以及对常用的抗菌药物进行药敏试验,采用Excel进行统计分析。结果 62例开放性骨折患者中术后发生感染的有12例,感染率19.35%;共分离出13株病原菌,其中革兰阳性菌占46.16%、革兰阴性菌占38.46%、真菌占15.38%;革兰阳性菌对除呋喃妥因、克林霉素、左氧氟沙星、利福平、四环素以及万古霉素敏感外,对其他的抗菌药物耐药率均达到50.00%以上,对青霉素、红霉素耐药率达100.00%;革兰阴性菌对氨苄西林、磺胺甲噁唑/甲氧苄啶的耐药率达100.00%。结论开放性骨折患者术后感染尤其是切口的感染多来自周围的内源性正常菌群或周围环境中的条件致病菌,临床医师需早期积极采取正确及时的清创处理及合理使用抗菌药物等,对于预防骨折术后感染有着积极重要的作用。

OBJECTIVE To investigate the distribution and drug resistance of common pathogens for postoperative infection in open fracture ,and to provide a basis for reducing postoperative infection of open fracture .METHODS Totally 62 patients with open fracture admitted from Jan .2011 to Jan .2014 in our hospital were studied .The distribution of common pathogens for the incidence of postoperative infection in patients was observed and the sus‐ceptibility analysis was conducted for common antimicrobial drugs .The software Excel was used for statistical analysis .RESULTS Totally 12 out of 62 patients with open fracture had infection ,the infection rate was 19 .35% . Totally 13 pathogens were isolated ,including gram‐positive bacteria accounting for 46 .15% ,gram‐negative bacte‐ria accounting for 46 .15% ,fungi accounting for 15 .38% .Gram‐positive bacteria were sensitive to antibiotics such as nitrofurantoin ,clindamycin ,levofloxacin ,rifampin ,tetracycline and vancomycin ,and resistant to other antibi‐otics with the resistance rate of more than 50% ,especially ,100% to penicillin and erythromycin .gram‐negative bacteria had a resistance rate of 100% to ampicillin and sulfamethoxazole/trimethoprim .CONCLUSION Postopera‐tive infection in patients with open fracture ,especially infection of the incision ,is mostly due to the normal endog‐enous flora or conditional pathogens in the surrounding environment .Clinicians need to make proper and timely early aggressive debridement and rational use of antimicrobial drugs ,which has a positive and important role for the prevention of postoperative infection of fracture .