骨科患者急性伤口感染的临床研究

Acute wound infections in orthopedic patients

目的研究骨科患者急性伤口感染状况,进行针对性治疗,以降低患者伤口感染程度。方法选择2013-2015年于医院进行治疗的骨科患者85例,并对其感染部位及病原菌分布进行分析,采用SPSS16.0统计软件对数据进行处理。结果 85例骨科患者发生急性伤口感染31例,感染率为36.5%;暴露表皮/真皮12例患者发生感染1例感染率8.3%,暴露肌肉骨骼46例患者发生感染17例感染率为37.0%,暴露皮下组织27例患者发生感染13例感染率48.1%,感染与暴露的伤口面积成正比,差异有统计学意义(P<0.05);伤口感染部位以手术切口感染为主占96.8%;感染病原菌以粪肠球菌D群及铜绿假单胞菌最多,各占22.6%,其次为鲍氏不动杆菌、肺炎克雷伯菌等,差异有统计学意义(P<0.05);通过对金黄色葡萄球菌及溶血葡萄球菌进行药物敏感试验,发现金黄色葡萄球菌对大部分抗菌药物敏感率达100.0%,而溶血葡萄球菌在总体上对抗菌药物敏感率要低于金黄色葡萄球菌,差异均有统计学意义(P<0.05)。结论骨科患者伤口特征、伤口部位等的不同,对感染率的高低有着一定的影响,不同病原菌感染后,用药也应有针对性治疗,以降低骨科患者的伤口感染程度。

OBJECTIVE To investigate the conditions of wound infections in orthopedic patients and conduct targeted therapy according to the different situation to treat wound infections by the maximum degree.METHODS Totally 85 cases of orthopedic patients treated in the hospital from the year 2013 to 2015were selected,and the infection sites and the pathogen distribution were analyzed.The statistical software SPSS16.0was used to process the data.RESULTS There were 31 cases of acute wound infections in the 85 orthopedic patients,with the infection rate of 36.5%.The infections occurred in 1of 12 patients who were exposed to epidermis or dermis,with the infection rate 8.3%;the infections occurred in 17 of 46patients who had exposure to muscle and bone,with the infection rate 37.0%;the infections occurred in 13 of 27patients who had exposure to subcutaneous tissues,with the infection rate 48.1%;the incidence of the infections was positively correlated with the wound exposure area（P〈0.05）.Of the patients with the wound infections,96.8% had the surgical incision infections.Enterococcus faecalis D group and Pseudomonas aeruginosa were the dominant bacteria,accounting for 22.6% respectively,followed by Acinetobacter baumannii,Klebsiella pneumoniae and so on,the above differences were significant（P〈0.05）.The drug sensitive test showed that Staphylococcus aureus had a sensitivity of 100.0%to most antibacterial drugs and the overall sensitivity of Staphylococcus haemolyticus was significantly lower than that of S.aureus（P〈0.05）.CONCLUSIONThe wound characteristics and wound sites have a certain influence on the infection rate.Targeted drug treatments should be performed after infections by different bacteria to reduce the degree of wound infections of orthopedic patients.