骨折术后切口感染相关因素分析

Analysis of incision infection related factors in patients with orthopedics surgery

目的探讨海口市骨外科手术患者术后切口感染的相关因素。方法选取2011年1月-2016年5月期间海口市6家三甲医院骨科收治的骨折且行骨外科手术的患者为研究对象,根据是否发生感染,将患者分为感染组和非感染组,分析两组患者性别、年龄、BMI值、手术时机、手术时间、手术的季节、骨折的类型、是否合并糖尿病、是否合并低蛋白血症、是否无指征使用抗菌药物情况,确定骨外科手术患者术后切口感染的相关因素。结果 9 014例骨外科手术患者术后切口感染58例,手术切口感染率为0.64%。感染患者感染切口送检标本共分离病原菌65株,其中有7例存在2种以上细菌感染。革兰阴性菌42株(64.6%),以铜绿假单胞菌(20株,30.8%)、大肠埃希菌(12株,18.5%)为主;革兰阳性菌23株(35.4%),以金黄色葡萄球菌(15株,23.1%)为主。分析结果显示,年龄、手术时机、手术的季节、骨折的类型、是否合并糖尿病、是否合并低蛋白血症、是否无指征使用抗菌药物均为骨外科手术患者术后切口感染的独立影响因素。结论通过加强医院感染的检测工作,针对性地采取应对措施,可有效预防术后切口感染的发生。

Objective To investigate incision infection related factors in patients with orthopedic surgery in Haikou.Methods We chose 9 014 patients,who had an bone fracture operation in 6 hospitals with the third class in Haikou during the period from January 2011 to June 2016. On the basis of infection,they were divided into infection group and non infection group. In order to make sure of incision infection related factors,these were taken into account： gender,age,BMI value,operation opportunity,operation time,the season,the type of fracture,whether with diabetes mellitus,whether with hypoalbuminemia,whether with antibiotic abuse. Results Among 9 014 cases,58 incision infections occurred,and the rate of incision infection was 0. 64%. We isolated 65 strains of pathogenic bacteria from the 58 cases,and 7 cases had more than 2kinds of bacterial species infections. 42 strains were gram negative bacteria（ 64. 6%）,20 strains were Pseudomonas aeruginosa（ 30. 8%）,and 12 strains were Escherichia coli（ 18. 5%）,23 strains were gram positive bacteria（ 35. 4%）,and 15 strains were Staphylococcus aureus（ 23. 1%）. The results indicated that all the factors as mentioned above were independent risk factors of incision infection. Conclusion In order to further reduce the incidence of incision infection in patients with orthopedic operations,we must strengthen the infection detectability in hospital,take targeted steps to prevent the occurrence of postoperative incision infection.