骨盆骨折患者术后医院感染的病原菌特点及危险因素分析

目的 分析骨盆骨折患者术后发生医院感染的病原菌分布、耐药及危险因素.方法 回顾性分析2012年6月至2017年6月582例骨盆骨折患者的临床资料,采用单因素和多因素分析确定骨盆骨折术后发生医院感染的病原菌分布、耐药及危险因素.结果 582例骨盆骨折术后感染患者共培养出132株病原菌,革兰阳性菌68株,革兰阴性菌62株,真菌感染2株.革兰阳性菌主要对青霉素耐药性最强,对万古霉素最弱.革兰阴性菌对庆大霉素耐药性最强,对美罗培南最弱.单因素分析和进一步Logicstics回归分析显示,年龄≥60、手术时间≥2h、骨质疏松、伤后至医院就诊时间≥6h、合并髋臼骨折和急诊手术是骨盆骨折患者术后发生医院感染独立的危险因素.结论 骨盆骨折术后发生医院感染的病原菌以革兰阳性菌为主,年龄≥60、手术时间≥2h、骨质疏松、伤后至医院就诊时间≥6h、合并髋臼骨折和急诊手术是骨盆骨折患者术后发生医院感染独立的危险因素.

Objective To analyze the distribution, drug resistance and risk factors of nosocomial infections in patients with pelvic fractures. Methods The clinical data of 582 patients with pelvic fracture admitted to orthopedics department in our hospital from June 2012 to June 2017 were retrospectively analyzed. Univariate and multivariate analyzes were performed to determine the distribution, drug resistance and risk of nosocomial infections in patients with pelvic fracture factor. Results A total of 132 pathogenic bacteria, 68 gram-positive bacteria, 62 gram- negative bacteria and 2 fungal infections were co-cultivated in 582 patients with pelvic fracture. Gram-positive bacteria had the strongest resistance to penicillin and the weakest to vancomycin. Gram-negative bacteria had the strongest resistance to gentamicin and the weakest to meropenem. Univariate analysis and further Logistic regression analysis showed that patients with pelvic fractures were hospital-acquired nosocomial infection after age≥60, operation time≥2h, osteoporosis, time to hospital after injury≥6h, combined acetabular fractures and emergency operation risk factors. Conclusions Gram-positive bacteria are the most common pathogenic bacteria in hospital after pelvic fracture. The patients with age≥60, operation time≥2h, osteoporosis, hospitalization time≥6h, complicated acetabular fractures and emergency operation are the independent risk factors of postoperative nosocomial infection in pelvic fracture.