骨科切口多重耐药感染的危险因素分析

Risk factors of multi-drug resistant wound infections after orthopaedic surgery

[目的]分析骨科手术切口多重耐药菌感染的相关危险因素,为临床采取有效措施提供参考。[方法]收集2011年6月~2015年12月骨科发生切口感染372例患者的临床资料,对其多重耐药菌感染的相关因素进行单因素与多因素统计分析。[结果]骨科手术4 651例,发生切口感染372例,感染发病率8.00%,住院时间≥10 d、营养不良、手术类型(急诊手术)、手术种类(有内置物)、手术部位(腰腹以下及下肢)、ASA分级(Ⅲ~Ⅳ级)、手术时间>2 h、切口长度>15 cm、出血量≥1 500 ml、损伤性治疗、卧床时间≥5 d、抗菌药物使用天数≥10 d、种类≥3种、联用3种以上抗菌药物、血红蛋白<90 g/L均是骨科手术切口多重耐药菌感染的危险因素(P<0.05),其中营养不良(OR2.231,95%CI1.100-4.524)、手术种类(有内置物)(OR3.773,95%CI1.718-8.288)、抗菌药物使用天数≥10 d(OR2.434,95%CI1.218-4.865)、联用3种以上抗菌药物(OR8.905,95%CI1.388-57.136)是骨科切口感染的独立危险因素。[结论]骨科切口感染与多种危险因素有关,其中营养不良、手术种类(有内置物)、抗菌药物使用天数≥10 d和联用3种以上抗菌药物是骨科切口感染的独立危险因素。

[Objective] To explore the risk factors of multi-drug resistant wound infections after orthopaedic surgery. [ Methods ] From June 2011 to December 2015, 4651 patients received orthopedics surgery. Of them, 372 patients had multi- resistant wound infection, with the infection rate of 8%. The risk factors of the infection were searched by univariate and multi- variate statistical analysis. [Results] The univariate analysis showed risk factors included follows： 〉10 days of hospitalization, malnutrition, type of surgery （emergency operation） , type of surgery （implants） , surgical site （waist and lower limb, ASA grading （grade III- IV） , operation time 〉 2 hours, incision length 〉 15 cm, bleeding volume ≥ 1 500 ml, iatrogenic injury, bed time 〉5 days, receiving antibacterial drug 〉 10 days, combined with 〉 3 kinds of antibacterial drugs, hemoglobin 〈 90 g/L, respectively （P〈0.05） . Additionally, the logistic regression analysis indicated that malnutrition （OR 2.231, 95%CI 1.100- 4.524） , the type of surgery （implants） （OR 3.773, 95%CI 1.718-8.288） , 〉10 days of antibiotic use （OR 2.434, 95%CI 1.218-4.865） , combined use 〉3 kinds of antibacterial drugs （OR 8.905, 95 %CI 1.388-57.136） were the independent risk factors. [Conclusion] Malnutrition, type of surgery （implants） , antibiotics drug use 〉10 days and combined use 〉3 kindsof antibacterial drugs are independent risk factors of wound infection in orthopaedic department.