四肢开放性骨折患者院内感染病原菌分布及耐药性分析

Analysis of drug resistance and pathogenic characteristics of nosocomial infections in patients with acral open fracture

目的:探讨四肢开放性骨折患者院内感染的病原菌分布特点和耐药情况。方法:选取2013年1月至2017年1月四川省内江市中医院收治的417例四肢开放性骨折患者为研究对象,对比院内感染患者与未发生院内感染患者的临床资料,留取感染患者创口分泌物进行细菌培养、鉴定及耐药性分析。结果:417例四肢开放性骨折患者中62例出现创口感染,感染发生率为14.87%。年龄大、创口留空腔、使用内固定、住院时间长以及患有基础病患者感染发生率显著提高(P<0.05);而不同性别及手术时间患者感染率比较,差异无统计学意义(P>0.05)。共分离出67株病原菌,其中排前5位的病原菌为表皮葡萄球菌、金黄色葡萄球菌、大肠埃希菌、粪肠球菌、铜绿假单胞菌,构成比分别为28.36%、19.40%、17.91%、11.94%、11.94%。表皮葡萄球菌、金黄色葡萄球菌和粪肠球菌对环丙沙星、万古霉素较为敏感,大肠埃希菌和铜绿假单胞菌对亚胺培南、庆大霉素较为敏感。结论:年龄偏大、留置空腔、内固定、住院时间长以及患有基础病的四肢开放性骨折患者较易发生院内感染;院内感染病原菌以革兰阳性菌为主,合理应用抗生素有助于降低院内感染发生率,提高治疗效果。

Objective： To explore the drug resistance and pathogenic characteristics of nosocomial infections in patients with acral open fracture. Methods： 417 patients with acral open fracture were enrolled in this study. The clinical data were compared between patients with and without nosocomial infections. The wound secretion was collected for bacterial cultures, and drug sensitive tests were detected. Results： 62 cases suffered nosocomi- al infections among 417 patients with acral open fracture, with the incidence of 14. 87%. The patients with elder- ly age, blank wound cavity, internal fixation, long hospital stay and basic disease had higher infection rate （P〈 0. 05）. There was no significant difference in infection rate among patients with different gender and operative duration （P〉 0. 05 ）. Totally 67 pathogenic strains were detected, among which the Staphylococcus epidermidis, Ataphylococcus aureus,Esherichia coli, Enterococcus faecalis and Pseudomonas aeruginosa, accounting for 28.36%, 19.40%, 17.91%, 11.94% and 11.94%, respectively. The sensitive drug of Staphylococcus epidermidis,Ata- phylococcus aureus, Enterococcus faecalis was Ciprofloxacin and Vancomycin, while the sensitive drug of Esh- erichia coli, Pseudomonas aeruginosa was imipenem and gentamicin. Conclusion： The acral open fracture pa- tients with elderly age, blank wound cavity, internal fixation, long hospital stay and basic disease are more sus- ceptible to infection. Gram-positive bacteria are the most common pathogen in patients with nosocomial infec- tions. Selecting antibiotics correctly can reduce rate of nosocomial infections and improve the cure rate.