胫腓骨开放性骨折术后并发感染的病原菌分布、耐药性及影响因素分析

Analysis of Distribution, Drug Resistance and Influencing Factors of Pathogen Causing Postoperative Infection in Open Tibial and Fibular Fractures

目的:研究胫腓骨开放性骨折术后并发感染患者的病原菌分布、耐药性及影响因素。方法:回顾性分析2014年1月到2018年1月于华北石油管理局总医院接受治疗的267例单侧胫腓骨开放性骨折患者的临床资料,统计术后感染病例,分析胫腓骨开放性骨折术后感染患者的病原菌分布情况,分析主要革兰阳性菌和主要革兰阴性菌的耐药性,采用单因素和多因素Logistic回归分析术后患者发生感染的危险因素。结果:267例患者发生术后感染68例,感染率为25.47%;68例患者共分离出病原菌82株,其中革兰阳性菌占64.63%,革兰阴性菌占28.05%,真菌占7.32%;金黄色葡萄球菌、表皮葡萄球菌、粪肠球菌对青霉素、哌拉西林/他唑巴坦耐药性较高,对万古霉素、亚胺培南比较敏感;大肠埃希菌、阴沟肠杆菌、铜绿假单胞菌、鲍氏不动杆菌对头孢唑林耐药性较高,对亚胺培南和头孢哌酮/舒巴坦比较敏感;单因素分析显示:受伤原因、骨折部位、有无合并糖尿病、受伤至手术时间、清创情况、止血情况、引流情况、术后有无使用抗菌药物均是导致胫腓骨开放性骨折术后发生感染的相关因素(P<0.05);多因素Logistic回归分析显示:受伤至手术时间>6 h、清创不彻底、止血不彻底、引流不通畅、术后未使用抗菌药物均是导致胫腓骨开放性骨折术后发生感染的危险因素(P<0.05)。结论:胫腓骨开放性骨折患者术后感染以革兰阳性菌为主,其对青霉素、哌拉西林/他唑巴坦敏感性较低,临床上应针对危险因素采取有效预防措施,并根据药敏试验选择有效药物治疗。

Objective: To study the distribution,drug resistance and influencing factors of pathogen causing postoperative infection in open tibial and fibular fractures. Methods: The clinical data of 267 patients with open fracture of tibia and fibula who were treated in General Hospital of North China Petroleum Administration from January 2014 to January 2018 were retrospectively analyzed. Postoperative infection cases was counted, the distribution of pathogens causing postoperative infection in open tibial and fibular fracture was analyzed, and antimicrobial resistance of major gram-positive bacteria and major gram negative bacteria was analyzed. Univariate and multivariate Logistic regression analysis was used to analyze the risk factors of postoperative infection. Results: Among 267 patients, 68 cases had occurred postoperative infection, the infection rate was 25.47%. 82 strains of pathogen were isolated from 68 patients, of which gram positive bacteria was accounted for 64.63%, gram-negative bacteria was accounted for 28.05%, fungi was accounted for 7.32%.Staphylococcus aureus, staphylococcus epidermidis, and enterococcus faecalis were more resistant to penicillin, piperacillin/tazobactam,which were more sensitive to vancomycin and imipenem. Escherichia coli, enterobacter cloacae, pseudomonas aeruginosa and acinetobacter baumannii were more resistant to cefazolin, which were more sensitive to imipenem and cefoperazone/sulbactam. Univariate analysis showed that the causes of injury, fracture site, diabetes, injury to operation time, debridement, hemostasis, drainage, and no use of antibiotics were all related factors causing postoperative infection in open tibial and fibular fractures(P<0.05). Multivariate Logistic regression analysis showed that the injury to the operation time >6 h, incomplete debridement, incomplete hemostasis, obstructed drainage and postoperative no use of antibiotics were all risk factors causing postoperative infection in open tibial and fibular fractures(P<0.05).Conclusion: Postoperative infection of tibiofibula open fractures is mainly caused by Gram-positive bacteria, and their sensitivity to penicillin and piperacillin/tazobactam is lower. Clinically, effective preventive measures should be taken against risk factors, and effective drug therapy should be selected according to drug sensitivity test.