关节置换术后患者院内感染病原学特点及耐药性分析

Etiologic characteristics and drug resistance of nosocomial infections after joint replacement

目的探讨关节置换术后患者院内感染细菌的耐药性及危险因素。方法对2008年1月-2016年12月于医院行全膝关节置换术、全髋关节置换术患者1125例,对术后发生院内感染的患者35例的临床资料进行回顾性分析,包括患者性别、年龄、肥胖程度(BMI指数)、术前住院时间、术前备皮时间、术中手术出血量、手术持续时间、术后尿管留置时间、基础疾病及用药情况等与发生院内感染的相关性。并对患者关节感染局部进行病原菌及耐药性分析。结果发生术后感染患者共35例,感染率为3.11%,共检出病原菌58株,其中革兰阴性菌31株占53.45%,以大肠埃希菌、铜绿假单胞杆菌为主;革兰阳性菌27株占46.55%,以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主。革兰阴性菌对常用抗菌药物如氨苄西林、头孢唑林等耐药性较高,对亚胺培南耐药率为0.00;革兰阳性菌中金黄色葡萄球菌对克林霉素、青霉素耐药性较高,凝固酶阴性葡萄球菌对头孢唑林、红霉素、青霉素、克林霉素有较高耐药性,均在50.00%以上。多因素Logistic结果显示:年龄≥60岁、BMI≥28、术中出血量≥1000ml在发生院内感染的过程中发挥着十分重要的作用(P<0.05)。结论关节置换术后影响院内感染发生的因素诸多,且感染病原菌耐药性强,应当合理选择抗菌药物,预防和减少耐药菌株的产生。同时做好感染预防措施,降低术后感染发生率。

OBJECTIVE To analyze the drug resistance of pathogenic bacteria and risk factors of nosocomial infections after joint replacement.METHODS A total of 1125 cases of patients with total knee arthroplasty and total hip replacement in our hospital from Jan.2008 to Dec.2016 were selected,and 35 cases with postoperative nosocomial infections were retrospectively analyzed.The patients＇ clinical data including gender,age,obesity degree（BMI index）,preoperative hospital stay,preoperative skin preparation time,intraoperative bleeding amount,duration of operationtime,indwelling time of urinary catheter after operation,underlying diseases and the use of drugs,and their correlation with nosocomial infection were recorded and znalyzed.The distribution and drug resistance of the bacteria in patients with postoperative joint infections were analyzed.RESULTS There were 35 cases with postoperative infections,and the infection rate was 3.11%.There were 58 strains of bacteria detected from the infected patients,including 31 strains of gram-negative-bacteria,accounting for 53.45%,mainly for Escherichia coli and Pseudomonas aeruginosa,and 27 strains of gram-positive bacteria,accounting for 46.55%,mainly for Staphylococcus aureus and coagulase-negative Staphylococcus.Drug resistance analysis showed that the gram-negative bacteria had high drug resistance to the commonly used antibiotics such as ampicillin and cefazolin while they had no resistance to imipenem.In gram-positive bacteria,S.aureus was highly resistant to clindamycin and penicillin,and coagulase-negative Staphylococcus had high resistance to erythromycin,penicillin,cefazolin,and clindamycin,and the resistant rates were more than 50%.Multivariate logistic analysis results showed that,age≥60 years old,BMI≥28 and intraoperative blood loss noless than 1000 ml play important roles in the occurrence of nosocomial infections（P〈0.05）.CONCLUSION There are many influencing factors affecting the nosocomial infections after joint replacement,and the pathogens are highly resistant.We should rationally selecte the antibiotics to prevent and reduce the generation of drug-resistant strains and take measures to prevent the infections to reduce the incidence of postoperative infections.