开放性骨折清创术感染病原菌与耐药性研究

Distribution and drug resistance of pathogens causing postoperative infections in open fracture patients undergoing debridement

目的探讨开放性骨折患者,清创术中发生感染后病原菌分布及耐药性分析,为临床诊治策略提供参考。方法回顾性分析2013年1月-2014年1月急诊72例四肢开放性骨折患者临床资料,均实施清创固定术且创口出现感染,分别于术中、感染后实施病原菌检测及耐药性对比分析。结果 3例患者在清创术中感染后病原菌培养检测出相同的病原菌,一致率为4.17%,且1例患者清创中金黄色葡萄球菌耐药性低,感染后耐药率高,清创术中、感染后耐药无相关性,清创术中表现为较敏感病原菌感染后多表现为耐药性较高;清创术中检出病原菌无多药耐药性存在,感染后有45株存在多药耐药性,鲍氏不动杆菌对头孢哌酮/舒巴坦、左氧氟沙星耐药率分别为42.50%、52.50%,其余耐药率高;金黄色葡萄球菌对红霉素耐药率40.00%,其余达100.00%;阴沟肠杆菌与铜绿假单胞菌耐药性均较低。结论开放性骨折手术患者术中清创的病原菌培养结果、耐药性与感染后无直接关系;革兰阴性菌是感染主要病原菌,且多药耐药性发生率较高。

OBJECTIVE To explore the distribution and drug resistance of pathogens causing infections in the open fracture patients during the debridement so as to provide guidance for clinical diagnosis and treatment.METHODS The clinical data of 72 patients with open fracture of limbs who were treated in the emergency department from Jan2013 to Jan 2014 were retrospectively analyzed;all the patients were treated with debridement and had the wound infections.The pathogens causing infections during the debridement were detected,and the drug resistance was observed and compared.RESULTS Totally 3patients have been detected the same species of pathogens causing the infections during the debridement,with the coincidence rate of 4.17%.The drug resistance rate of the Staphylococcus aureus isolated from 1patient during the debridement was low but was high after the infection,the drug resistance during the debridement was not associated with the drug resistance after the infection.The pathogens that presented high susceptibility during the debridement presented high drug resistance after the infection.No strain of multidrug-resistant pathogen was detected during the debridement,while 45 strains of multidrug-resistant pathogens were detected after the infection.The drug resistance rates of the Acinetobacter baumannii to cefoperazone-sulbactam and levofloxacin were 42.50% and 52.50%,respectively;and the drug resistance rates to other antibiotics were high.The drug resistance rate of the S.aureus to erygthromycin was 40.00%,and the drug resistance rate to other antibiotics was 100.00%.The drug resistance rates of Enterobacter cloacae and Pseudomonas aeruginosa were low.CONCLUSION The results of culture and drug resistance of the pathogens isolated from the open fracture patients during the debridement are not directly associated with the pathogens causing postoperative infections.The gram-negative bacteria are dominant among the pathogens causing the infections and are highly multidrug-resistant.