骨折清创术前感染病原菌分布与耐药性分析

Correlation analysis of pathogen distribution and resistance before debridement and after infections in fracture patients

目的探讨骨折患者病原菌分布及耐药性在清创术前与发生感染后相关性,并分析能否利用清创术前培养结果选择预防感染用药。方法选择2012年5月-2014年5月144例实施开放性骨折患者,所有患者术前实施清创固定术,术后发生感染,在清创术前以及确认感染后分别进行病原菌监测及耐药性分析,对比前后两次结果,探讨相关性。结果术前培养出42株病原菌,其中革兰阴性菌28株占66.67%、革兰阳性菌14株占33.33%,金黄色葡萄球菌对头孢呋辛耐药率高达91.67%,其余病原菌对主要抗菌药物耐药率较低,均<30.00%,未发现多药耐药性;术后培养出166株病原菌,其中革兰阴性菌150株占90.36%、革兰阳性菌16株占9.64%,鲍氏不动杆菌总体耐药率较高,对亚胺培南耐药率低为11.25%,且存在多药耐药性。结论骨折手术患者感染病原菌主要为革兰阴性菌;但术前培养结果与术后培养结果无相关性,不能根据术前培养结果预见性预防术后感染。

OBJECTIVE To investigate correlation of pathogen distribution and resistance before debridement with occurrence of infections in fracture patients so as to analyze whether the bacterial culture results before debridement can be used as a reference for drug use for infection prevention.METHODS Totally 144 fracture patients from May 2012 to May 2014 were selected,and all patients received debridement and fixation before surgery and had infections after surgery.The pathogen monitoring and the drug resistance analysis were conducted before debridement and after confirmation of infection.Results of pathogen distribution and resistance before debridement and after infections were compared to investigate the correlation.RESULTS Before surgery,40 patients were isolated with 42 strains of pathogenic bacteria,28 strains were gram-negative bacteria（66.67%）,14 strains were gram-positive bacteria（33.33%）,the drug resistance of Staphylococcus aureus against cefuroxime were up to 91.67%,other bacteria had low drug resistance of〈30.00% against main antibiotics,no multiple drug resistance was detected.After surgery,166 strains of pathogenic bacteria were isolated,among which there were 150 strains of gram-negative bacteria（90.36%）and 16 strains of gram-positive bacteria（9.64%）.Acinetobacter baumannii had high drug resistance against main antibiotics,but drug resistance against imipenem was11.25%,and multiple drug resistance was detected.CONCLUSIONInfectious pathogens in fracture patients are mainly gram-negative bacteria,but there is no correlation in culture results before debridement and after infections,therefore,the pre-surgical culture results cannot be used as a reference to forecast post-surgical infections.