关节外科手术患者多药耐药菌监测及感染影响因素研究

Monitoring of multidrug resistant bacteria and the risk factors of infections in patients with joint surgery

目的分析关节外科手术患者多药耐药菌监测结果特征及感染的影响因素,为预防与控制多药耐药菌感染提供参考依据。方法选择2016年1月-2017年12月于医院关节外科接受关节手术的住院患者958例为研究对象,通过医院感染实时监测系统回顾性调查患者多药耐药菌目标性监测情况,分析术后患者多药耐药菌的分布特征,以单因素和多因素Logistic回归分析筛选出引起多药耐药菌感染的影响因素。结果 958例关节疾病患者中,有70例MDROs感染患者,共检出70株MDROs;以ELBLs 33株占47.14%为主,其次为MRSA 23株占32.86%;感染部位以呼吸道感染31株占44.29%为主,其次为创面感染17株占24.29%;多因素Logistic回归分析结果显示,住院时间≥15d、手术时间≥180min、抗菌药物使用时间≥10d、并发糖尿病、开放性损伤、既往关节手术史和血清白蛋白<35g/L为关节患者术后MDROs感染的影响因素。结论引起MDROs感染的影响因素较多,应尽量缩短住院时间、有效治疗并发基础疾病、合理使用抗菌药物、纠正低蛋白血症等,有效降低骨关节疾病患者术后MDROs感染发生率。

OBJECTIVE To analyze the characteristics of multidrug resistant bacteria monitoring results and the risk factors of infections in patients with joint surgery, so as to provide references for prevention and control of multi- drug resistant bacteria infections. METHODS A total of 958 patients with joint surgery from Jan. 2016 to Dec. 2017 were selected as the research objects. Through retrospective review of the multidrug resistant bacteria target monitoring real-time monitoring system of hospital infection, the distribution characteristics of the postoperative patients with multidrug resistant bacteria were analyzed, and the risk factors for multidrug resistant bacteria infec- tion were analyzed by the univariate and multivariate logistic regression analysis. RESULTS Totally 70 cases had MDROs infection among 958 patients, and 70 strains of MDROs were detected. Among them, ELBLs and MRSA were 33 and 23 strains, accounting for47.14 % and 32.86%. The main infection site was respiratory tract infection, which was 31 strains and accounted for 44.29%, followed by 17 strains of wound infection, accounting for 24.29 M, Multivariate logistic regression analysis showed that the days of hospitalizationS15 d, duration of opera- tion≥180 min, time of antibiotics used≥10 d, diabetes mellitus, open injury, history of joint operation and serum albuminS35 g/L were independent risk factors for postoperative MDROs infection in joint patients （P《0.05）. CONCLUSION There are many risk factors for MDROs infection. We should minimize hospitalization time, effec- tively treat concurrent diseases, rationally use antibiotics and correct hypoproteinemia, so as to effectively reduce the incidence of MDROs infection in patients with osteoarthrosis.