骨科医院感染病原菌分布及抗菌药物使用情况调查分析

Distribution of pathogenic bacteria and antimicrobial usages in orthopedic hospital-acquired infection patients:a large sample investigation on 7966 cases

[目的]调查分析骨科医院感染患者病原菌分布及抗菌药物使用情况。[方法]采用回顾性调查方法对2013年1月~2015年9月骨科住院的7 966例患者进行监测分析。[结果]113例患者发生医院感染,医院感染率为1.42%,例次感染率为1.53%;医院感染部位分布：泌尿系统感染（22.31%）所占比例最高,其次为手术部位感染（14.88%）和下呼吸道感染（14.88%）;122例次感染有24例次未送检,送检标本分离出94株病原菌,革兰阴性杆菌55株,占58.51%,分布最多的是大肠埃希菌占18.08%,革兰阳性球菌32株,占34.04%,金黄色葡萄球菌,占9.58%,真菌7株,占7.45%;抗菌药物使用频率排在前三位的分别是：环丙沙星（30.09%）、左氧氟沙星（27.43%）、头孢呋辛（27.43%）。Ⅰ联用药103例,平均使用天数12.52 d,Ⅱ联用药16例,平均使用天数5.44 d,Ⅲ联用药3例,平均使用天数7.00 d。[结论]引起骨科医院感染的病原菌分布较为广泛,应根据微生物培养及药敏试验合理使用抗菌药物。

[ Objective] To investigate the distribution of pathogenic bacteria and the use of antibacterial agents in orthope- dic hospital -acquired infection patients. [ Methods] A retrospective study was carried out to analyze 7 966 cases in orthopedic department of our hospital from January 2013 to September 2015. The Diagnosis Standard for Hospital - acquired Infection pub- lished by Ministry of Health was used to confirm the infection [ Results] A total of 113 patients with hospital - acquired infec- tion were found out, with the total infection rate of 1.42% , and the case - times rate of 1.53%. In the distribution of hospital - acquired infection, urinary tract infection （22. 31% ） was the highest, followed by the operation site infection （ 14. 88% ） and lower respiratory tract infection （ 14.88% ） . Twenty - four cases did not submit for inspection in 122 case - times of infec- tion. Ninty - four strains of pathogenic bacteria were isolated, which included 55 strains （58.51% ） of Gram - negative bacillus, 32 strains （34. 04% ） of Gram - positive bacillus and 7 strains of fungus （7.45%） . The largest distribution in Gram - negative and - positive bacteria were escherichia coli, accounting for 18.08% and staphylococcus anreus, accounting for 9. 58% , re- spectively. The top three antimicrobial drug usage -frequency were ciprofloxacin （30. 09% ） , levofloxacin （27.43%） and cefu- roxime （27.43%） . The average days of drug usage for single drug （ 103 cases） , double - drug （ 16 cases） and three - drug （3 cases） were 12. 52, 5.44 and 7.00 days respectively. [ Conclusion] The bacteria causing the hospital - acquired infection are widely distributed in orthopedics. Antibacterial drugs must be used following the results of microbial culture and drug sensitivity test.