髋关节置换术后患者医院感染的临床特征与耐药性分析

Clinical features,drug resistance and treatment measures of nosocomial infections in patients after hip replacement

目的分析髋关节置换术后患者医院感染的病原菌分布及耐药性,为合理用药提供依据。方法选择2009年5月-2014年5月80例髋关节置换术后医院感染患者临床资料,将其随机分为试验组40例和对照组40例,分析患者医院感染部位、病原菌种类及其对常用抗菌药物的耐药性。结果患者医院感染主要部位为手术切口占38.75%,其次为呼吸系统和消化系统,分别占21.25%和18.75%;共分离出97株病原菌,其中革兰阳性菌72株占74.23%,革兰阴性菌20株占20.62%,真菌5株占5.15%;金黄色葡萄球菌和表皮葡萄球菌耐药严重,其对万古霉素耐药率较低;革兰阴性菌对青霉素、红霉素耐药严重,而对阿米卡星、万古霉素耐药率较低;试验组总有效率为95.00%,显著高于对照组80.00%,两组比较差异有统计学意义(χ2=10.286,P<0.05)。结论髋关节置换术后患者医院感染的主要部位为手术切口,其中革兰阳性菌感染为主,对于发生感染的患者,需要根据药敏试验选择合适抗菌药物治疗,必要时可与人免疫球蛋白联合治疗。

OBJECTIVE To analyze the clinical features and drug resistance of nosocomial infections in patients after hip replacement so as to provide reference for rational drug use.METHODS Totally 80 cases of patients with nosocomial infections after hip replacement were selected and randomly divided into the experimental group of 40 cases and the control group of 40 cases.The nosocomial infection sites,pathogen species and resistance to antibiotics were analyzed.RESULTS The main sites for nosocomial infections were mainly operation incision accounting for 38.75%,followed by respiratory system（21.25%）and digestive system（18.75%）.Totally 97 strains of pathogenic bacteria were isolated from the 80 patients,including 72 gram positive strains accounting for74.23%,20 gram negative bacteria accounting for 20.62%,5strains of fungi accounting for 5.15%.The results of drug sensitivity test showed that Staphylococcus aureus and Staphylococcus epidermidis had serious drug resistance and had the lowest resistance to vancomycin.Gram-negative bacteria had serious resistance to penicillin and erythromycin and the lowest resistance to amikacin and vancomycin.The total effective rate was 95.00%in the experimental group,significantly higher than 80.00% in the control group（χ^2=10.286,P 〈0.05）.CONCLUSIONThe main site of nosocomial infections after hip replacement was operation incision,gram positive bacteria were the prevalent pathogens.For infected patients,appropriate antibiotics treatment should be selected according to the drug sensitivity test,when necessary,the treatment can be combined with human immunoglobulin therapy.