个性股骨假体置换术后患者感染病原菌分布及耐药性研究

Distribution and drug resistance of pathogens in patients with individual femoral prosthesis replacement

目的探究采用医用CT技术结合计算机辅助设计重建个性股骨假体并进行置换术后感染病原菌的分布、耐药性、感染部位及危险因素。方法选取2011年7月-2016年6月于医院接受股骨假体置换术的患者202例,回顾患者的临床资料,个性化分析股骨假体置换术后感染的危险因素,经无菌操作,对感染患者标本进行病原菌培养、分离和鉴定,并经药敏试验了解其耐药性。结果股骨假体置换术的202例患者中有36例感染患者,感染率为17.82%;36例股骨假体置换术感染患者分离出病原菌46株,以革兰阳性菌为主,共31株占67.39%;主要革兰阳性菌对青霉素、头孢克洛、头孢呋辛、头孢唑林的耐药率较高,均≥50.00%,对万古霉素的耐药率较低;Logistic多元回归分析结果显示,年龄、手术时间、术中输血量、引流时间、是否长期使用抗菌药物、血红蛋白、血清白蛋白是股骨假体置换术后感染的独立危险因素(P<0.05)。结论个性股骨假体置换术后患者的感染病原菌以革兰阳性菌为主,且耐药率较高。

OBJECTIVE To explore the distribution,drug resistance,infection sites and risk factors of pathogens after operation in patients with individual femoral prosthesis and the replacement with medical CT technique combined with computer aided design.METHODS A total of 202 patients who received femoral prosthesis replacement in our hospital from Jul.2011 to Jun.2016 were selected.The clinical data of the patients were analyzed,and the risk factors of infections after femoral prosthesis replacement were analyzed.The aseptic technique was used to select the secretions of the infected parts and the pus and so on.The pathogens were cultured,separated and identified,and drug sensitivity test was used to analyze its drug resistance.RESULTS Among the 202 patients with femoral prosthesis replacement,36 cases were infected,with the infection rate of 17.82%.Totally 46 strains of pathogens were isolated,which were mainly 31 strains of gram-positive bacteria,accounting for 67.39%.The results showed that major gram-positive bacteria had high resistant rates to penicillin,cefaclor,cefuroxime and cefazolin,which were all greater than 50%,and had low resistant rate to vancomycin.Multivariate Logistic regression analysis showed that age,operative time,intraoperative blood transfusion volume,drainage time,whether long-term use of antibiotics,hemoglobin and serum albumin were independent risk factors for postoperative infections of femoral prosthesis replacement.CONCLUSIONThe main pathogens in patients with individual femoral prosthesis replacement are gram-positive bacteria,and the resistant rates are high.