胫腓骨开放性骨折术后感染的细菌学培养分析

Analysis on results of bacteria culture patients with postoperative infection after receiving operation of open fractures of tibia and fibula

目的分析胫腓骨开放性骨折术后感染的细菌学培养和药敏试验结果。方法选取2013年3月至2015年3月收治的150例胫腓骨开放性骨折并发术后细菌感染患者为研究对象,采集患者切口处标本,进行细菌培养和药敏试验。结果 687例胫腓骨开放性骨折患者中有150例患者术后出现细菌感染,感染率为21.83%。大肠埃希菌的构成比最高,为28.00%,凝固酶阴性葡萄球菌与褪色沙雷菌分别占20.67%、16.67%;所占构成比最小的是鲍曼不动杆菌,占2.00%。大肠埃希菌对亚胺培南和美罗培南的耐药率较低,分别为9.52%和11.90%;褪色沙雷菌对磺胺甲噁唑/甲氧苄啶和美罗培南的耐药率较低,均为8.00%;铜绿假单胞菌对美罗培南、头孢他啶和庆大霉素的耐药率较低,均为12.50%;阴沟肠杆菌对美罗培南和磺胺甲噁唑/甲氧苄啶的耐药率较低,分别为13.33%和20.00%。金黄色葡萄球菌对万古霉素的耐药率最低,为0;而凝固酶阴性葡萄球菌对万古霉素和呋喃妥因的耐药率较低,分别为6.45%和16.13%。结论胫腓骨开放性骨折术后发生细菌感染的概率较高,应该采取积极的措施预防术后切口感染,若发生细菌感染,应该根据药敏试验结果选择合适的抗菌药物开展治疗。

Objective To analyze the results of bacteria culture and sensitivity test of patients with postoperative infection after receiving operation of open fractures of tibia and fibula.Methods From March 2013 to March 2015,a total of 150 patients with bacterial infection after receiving surgery of open fracture of tibia and fibula were selected in this study,and the samples from the surface of wound were collected for bacterial culture and sensitivity testing.Results Among 687 open fractures of the tibia and fibula patients receiving surgery,150 patients with postoperative bacterial infection,the infection rate was 21.83%.The highest proportion of bacterial tested was Escherichia coli（28.00%）,followed by Coagulase-negative staphylococci and Fading marcescens,the proportions were 20.67% and 16.67% respectively,the smallest component ratio was Acinetobacter baumannii,accounting for2.00%.The drug resistance rates of Escherichia coli to imipenem and meropenem were low,which were 9.52% and 11.90% respectively.The drug resistance rates of Fading marcescens to marcescens sulfamethoxazole/trimethoprim and meropenem were low,all of them were 8.00%.The drug resistance rates of Pseudomonas aeruginosa strains to meropenem,ceftazidime and gentamicin were 12.50%.The drug resistance rates of Enterobacter cloacae to meropenem and sulfamethoxazole/trimethoprim were 13.33%and 20.00% respectively.The drug resistance rate of Staphylococcus aureus to vancomycin was lowest as 0.While drug resistance rates of coagulase-negative staphylococci to vancomycin and nitrofurantoin were 6.45% and 16.13% respectively.ConclusionOpen fracture of tibia and fibula patients has high risk of postoperative bacterial infection,should take active measures to prevent postoperative infection.In case of bacterial infection,antibiotics should be selected based on susceptibility test results.