23例胫腓骨开放性骨折患者发生医院感染的临床分析

Clinical analysis on nosocomial infections in 23 patients with open tibia and fibula fractures

目的探讨胫腓骨开放性骨折患者发生医院内感染的危险因素,采取正确的预防措施,以降低感染的发生。方法以2008年4月至2015年3月于本院住院手术治疗的胫腓骨开放性骨折298例患者做为研究对象,对其相关资料进行回顾性分析,并对出现医院感染的23例患者进行相关危险因素分析。结果 298例胫腓骨开放性骨折患者发生医院内感染23例,感染率为7.72%。其中切口感染占39.13%,泌尿道和下呼吸道感染分别占21.74%和17.39%。单因素分析显示,感染与年龄(>60岁)、基础性疾病、骨折分型为Ⅲ型、曾有侵入性操作、抗菌药物使用不合理及住院时间长(≥20 d)相关(P均<0.05)。采用Logistic回归分析模式,筛选出4个独立危险因素,依次为:骨折分型(P=0.006)、侵入性操作(P=0.017)、基础性疾病(P=0.023)和患者年龄(P=0.048)。结论胫腓骨开放性骨折患者发生医院感染与多种因素相关,针对相关危险因素采取积极正确的预防和措施,减少医院感染的发生。

Objective To investigate the open tibia and fibula fractures risk factors of nosocomial infection, and to take correct prevention measures to reduce infection. Methods The clinical data of 298 cases of the open tibia and fibula fractures patients who had surgery in our hospital during April 2008 to March 2015 were collected, the related data were analyzed, retrospectively; while the risk factors of the nosocomial infections in 23 patients were analyzed, respectively. Results There were 23 patients occurred nosocomial infection in 298 patients with open tibia and fibula fractures, the infection rate was 7.72%. The incidence of incisional infection was 39.13%, followed by urinary tract （21.74%） and lower respiratory tract （17.39%）. There was significant correlation among age （〉 60 years old）, underlying disease, Gustilo-Anderson type Ⅲ fracture, invasive operation, irrational use of antibiotics, hospital stays （〉 20 days） （all P 〈 0.05）. Logistic analysis showed the risk factors for hospital infection were fracture classification （P = 0.006）, invasive operation （P =0.017）, underlying disease （P = 0.023） and age （P = 0.048）. Conclusions Patients with tibiofibula open fractures occur nosocomial infection is associated with a variety of factors, for related risk factors for correct prevention and measures should be taken to reduce the occurrence of hospital infection.