骨科创面感染病原学特征分析

Monitoring the pathogenic features of orthopedic surgical site infections

目的监测骨科创面感染病原学特征,指导临床抗感染防治。方法收集244例骨科创面感染患者临床资料,分离培养病原菌并鉴定。结果 244例骨科创面感染患者,四肢、躯干、头颈感染患者206、25、13例,分别占84.43%、10.25%和5.33%。创伤、切口、坏疽、溃疡、伤口、脓液、血液、褥疮引发的患者感染171、33、19、12、5、2和2例,分别占70.08%、13.52%、7.79%、4.92%、2.05%、0.82%和0.82%。共分离103株病原菌,包括革兰阴性菌59株,革兰阳性菌40株,真菌4株;革兰阴性菌中,大肠埃希菌、阴沟肠杆菌、铜绿假单胞菌、肺炎克雷菌、鲍曼不动杆菌、流感嗜血杆菌、奇异变形杆菌、其他G-分别占15.53%、12.62%、8.74%、5.83%、2.91%、2.91%、1.94%和6.80%;革兰阳性菌中,表皮葡萄球菌、金黄色葡萄球菌、屎肠球菌、粪肠球菌、肺炎链球菌、化脓性链球菌、溶血葡萄球菌、其他G+分别占14.56%、10.68%、3.88%、2.91%、1.94%、0.97%、0.97%和2.91%;真菌中,白色假丝酵母菌、近平滑假丝酵母菌、热带假丝酵母菌分别占1.94%、0.97%和0.97%;小儿、青少年、青年、中年和老年患者病原菌分离率分别为41.38%、35.00%、28.57%、28.85%和56.98%;15例学生患者、127例工人及农民患者、27例办公室人员患者、64例服务业人员患者、11例其他职业患者感染病原菌分离率分别为26.67%、56.69%、22.22%、29.69%和18.18%。结论骨科创面感染以革兰阴性菌为主,主要是大肠埃希菌。免疫力低的患者以及长期从事体力劳动的患者更易发生感染,临床应给予重视。

Objective To monitor the pathogenic features of orthopedic surgical site infections to guide the prevention and treatment of infections. Methods Clinical data were collected on 244 patients with an orthopedic surgical site infection,and pathogens were isolated,cultured and identified.Data were statistically analyzed. Results Of 244 patients with an orthopedic surgical site infection,206（84.43%）had a limb infection,25（10.25%）had a torso infection,and 13（5.33%）had a head or neck infection.The infection occurred as a result of trauma in 171 patients（70.08%）,as a result of an incision in 33（13.52%）,as a result of gangrene in 19（7.79%）,as a result of an ulcer in 12（4.92%）,as a result of pus in 5（2.05%）,as a result of blood in 2（0.82%）,and as a result of pressure ulcers in 2（0.82%）.One hundred and three strains of pathogens were isolated,including 59 strains of Gram-negative bacteria,40 strains of Gram-positive bacteria,and 4 strains of fungi.Gram-negative bacteria consisted of Escherichia coli（15.53%）,Enterobacter cloacae（12.62%）,Pseudomonas aeruginosa（8.74%）,Klebsiella pneumoniae（5.83%）,Acinetobacter baumannii（2.91%）,Haemophilus influenzae（2.91%）,Proteus mirabilis（1.94%）,and other Gram-negative bacteria（6.80%）.Gram-positive bacteria consisted of Staphylococcus epidermidis（14.56%）,S.aureus（10.68%）,Enterococcus faecium（3.88%）,E.faecalis（2.91%）,S.pneumoniae（1.94%）,S.pyogenes（0.97%）,S.haemolyticus（0.97%）,and other Gram-positive bacteria（2.91%）.Fungi consisted of Candida albicans（1.94%）,C.parapsilosis（0.97%）,and C.tropicalis（0.97%）.Pathogens were isolated from children at a rate of 41.38%,from adolescents at a rate of35.00%,from young adults at a rate of 28.57%,from the middle-aged at a rate of 28.85%,and from the elderly at a rate of 56.98%.Pathogens were isolated from 15 students（26.67%）,127 workers or farmers（56.69%）,27 office workers（22.22%）,64 workers in the service industry（29.69%）,and 11 patients in other jobs（18.18%）. ConclusionIn patients with an orthopedic surgical site infection,the pathogen causing that infection was mainly Gram-negative bacteria,and E.coli was the predominant bacterium.Patients with compromised immunity and who have engaged in physical labor for a prolonged period are more susceptible to an infection.Greater attention should be paid to these factors in clinic settings.