全髋关节置换术后合并肺部耐药菌感染的危险因素分析

Analysis of the risk factors for pulmonary drug-resistant bacterial infection after total hip replacement

目的探讨全髋关节置换术后合并肺部耐药菌感染的危险因素。方法选择成都第一骨科医院2012年1月至2018年1月收治的520例行全髋关节置换术的患者为研究对象,统计患者术后合并肺部耐药菌感染情况、感染病原菌分布及耐药情况,并分析术后合并肺部耐药菌感染的危险因素。结果 520例行全髋关节置换术的患者术后发生肺部耐药菌感染48例(9.23%),共分离出59株病原菌。主要革兰阴性菌中,肺炎克雷伯菌对头孢哌酮和头孢呋辛耐药率较高,分别为75.00%和58.33%;铜绿假单胞菌对头孢呋辛和头孢哌酮耐药率较高,分别为80.00%和60.00%。主要革兰阳性菌中,金黄色葡萄球菌对青霉素G和红霉素耐药率较高,分别为80.00%和70.00%。年龄≥65岁、手术时间≥150分钟、住院天数≥30天、预防性使用抗菌药物、合并糖尿病、合并肺部疾病及卧床时间>7天均为全髋关节置换术后合并肺部耐药菌感染的独立危险因素(P_均<0.05)。结论全髋关节置换术后合并肺部耐药菌感染受多种因素影响,需按照危险因素采取针对性预防措施,预防术后肺部耐药菌感染。

Objective To explore the risk factors of pulmonary drug-resistant bacterial infection after total hip replacement. Method 520 patients underwent total hip replacement from January 2012 to January 2018 in the Number One Orthopedics Hospital of Chengdu were selected as the subjects. The incidence of pulmonary drug-resistant bacterial infection, the distribution and drug resistance of pathogens and the risk factors of pulmonary drug-resistant bacterial infection were analyzed. Result In the 520 patients underwent total hip arthroplasty, there were 48 cases（9.23%） of pulmonary drug-resistant bacterial infection after operation, 59 strains of pathogenic bacteria were isolated. Among the main Gram-negative bacteria, Klebsiella pneumoniae had higher resistance rates to Cefoperazone and Cefuroxime, 75.00% and 58.33% respectively; the resistance rates of Pseudomonas aeruginosa to Cefuroxime and Cefoperazone were 80.00% and 60.00% respectively. Among the main Gram-positive bacteria, the resistance rates of Staphylococcus aureus to Penicillin G and Erythromycin were 80.00% and 70.00% respectively. Age ≥ 65 years old, operation time ≥ 150 minutes, hospitalization days ≥ 30 days, preventive use of antimicrobial agents, combined with diabetes mellitus, combined with pulmonary disease, and bed time 7 days were all the independent risk factors for pulmonary drug-resistant bacterial infection after total hip replacement（Pall〈0.05）. Conclusion The infection of pulmonary drug-resistant bacteria after total hip replacement is affected by many factors, targeted preventive measures should be taken according to risk factors to prevent postoperative pulmonary drug-resistant bacteria infection.