老年骨科手术患者行气管插管全身麻醉术后医院感染病原菌和耐药性与影响因素分析

Analysis of pathogens,drug resistance and influencing factors of nosocomial infections after general anesthesia for tracheal intubation in elderly patients in department of orthopedics

目的探讨老年骨科手术患者行气管插管全身麻醉术后医院感染病原菌特点和耐药性及影响因素。方法选择2010年1月-2017年9月于医院择期行骨科手术的患者1 800例,均行气管插管全身麻醉。采取患者标本,进行培养及耐药性试验;调查患者临床资料。观察术后医院感染情况和感染部位分布,感染病原菌特点及药敏试验结果,术后医院感染的影响因素。结果 1 800例老年骨科手术患者中有81例发生术后感染,感染发生率为4.50%;术后感染部位以肺部感染49例占60.49%为主;81例术后感染患者共分离培养病原菌97株,其中革兰阴性菌53株占54.64%、革兰阳性菌37株占38.14%、真菌7株占7.22%;主要革兰阴性菌对亚胺培南和美罗培南较敏感,主要革兰阳性菌对替考拉宁和万古霉素较敏感;多元Logistic分析结果显示,手术时间≥120 min、住院时间≥14d、糖尿病史、皮肤黏膜溃烂、低蛋白血症和术中植入物为术后医院感染的影响因素。结论术后医院感染发生以肺部感染为主,感染病原菌以革兰阴性菌为主,影响术后医院感染因素较多,故应合理应用抗菌药物及针对感染因素做好相关预防工作。

OBJECTIVE To investigate the pathogens,drug resistance and related factors of nosocomial infections after general anesthesia for tracheal intubation in elderly patients in department of orthopedics.METHODS From Jan.2010 to Sep.2017,1800 patients undergoing elective operation in department of orthopedics were selected.All patients underwent tracheal intubation and general anesthesia.The specimens were taken for culture and drug resistance test,and the clinical data of the patients were investigated.The postoperative nosocomial infections and infection sites,pathogen distribution and drug sensitivity test results,and the influencing factors of postoperative nosocomial infection were observed and analyzed.RESULTS There were 81 cases of postoperative infection in the1800 cases of elderly patients in department of orthopedics,and the infection rate was 4.50%,which were mainly49 cases of pulmonary infection,accounting for 60.49%.There were 97 strains of pathogenic bacteria isolated from 81 cases of postoperative infection,including 53 strains of gram-negative bacteria accounting for 54.64%,37 strains of gram-positive bacteria accounting for 38.14%,and 7 strains of fungi accounting for 7.22%.The main gram-negative bacteria were sensitive to imipenem and meropenem,and the main gram-positive bacteria were highly sensitive to teicoplanin and vancomycin.Multivariate logistic analysis showed that operation time ≥120 min,length of stay≥14 d,diabetes history,mucocutaneous ulceration,hypoproteinemia,and intraoperative implants were independent risk factors for postoperative nosocomial infection.CONCLUSIONPulmonary infection is the main infection of postoperative nosocomial infection,and the pathogenic bacteria are mainly gram-negative bacteria.There are many factors affecting the postoperative nosocomial infection.Therefore,antibiotics should be applied reasonably and the related prevention measures should be taken in accordance with the infection factors.