骨折切口感染经负压创面治疗的炎症因子分析

An Analysis of Pathogenic Bacteria and Drug Sensitivity of Postoperative Incision Infection and Prediction Value of Inflammatory Factors in Patients with Traumatic Fracture

目的探讨开放性骨折患者术后切口感染病原菌、药敏分析、炎症因子预测价值及负压创面治疗之后的动态变化。方法选取2016年1月至2018年12月收治的310例开放性骨折患者为研究对象,观察感染组患者术后切口感染情况及病原菌分布、并分析主要病原菌耐药情况,比较术后切口感染患者与未感染患者炎症因子水平,并采用受试者工作特征曲线(ROC)下面积(AUC)比较炎症因子对术后切口感染的预测价值。之后用负压创面治疗对感染切口进行治疗,动态观察创面愈合及炎症因子指标。结果术后发生切口感染的患者共有23例(7.42%);培养分离病原菌32株,其中革兰阴性菌18株,主要有铜绿假单胞菌、大肠埃希菌和鲍氏不动杆菌,革兰阳性菌12株,主要有金黄色葡萄球菌、溶血葡萄球菌和表皮葡萄球菌,真菌2株,主要是白假丝酵母。革兰阴性菌对头孢吡肟、头孢曲松和头孢他定耐药率较强,对美罗培南、亚胺培南和氨曲南敏感性较强。革兰阳性菌对青霉素和红霉素耐药率较强,金黄色葡萄球菌对四环素敏感性较强,溶血葡萄球菌对左氧氟沙星敏感性较强。术后切口感染患者降钙素原(PCT)、白介素(IL)-6、超敏C反应蛋白(hs-CRP)和红细胞沉降率(ESR)水平明显高于未感染组( P <0.05);ESR、hs-CRP、IL-6和PCT对术后切口感染的AUC值分别为0.810、 0.873 、0.917和0.854。通过负压创面治疗,患者创面感染均得到有效控制,且验证指标都呈明显降低趋势。结论开放性骨折患者术后切口感染主要以革兰氏阴性菌为主,革兰氏阳性菌其次,对切口感染患者实施抗菌药时,应严格按照耐药试验结果合理应用抗菌药;此外切口感染患者炎症因子水平明显高于未感染者,对判断患者术后是否感染病原菌具有一定的预测价值。同时负压创面治疗对此类患者有效,各炎症指标在治疗后明显减低。

Objective To investigate the pathogenic bacteria and drug sensitivity of postoperative incision infection and the predictive value of inflammatory factors in patients with traumatic fracture. Methods A total of 310 patients from Jan,2016 to Dec,2018 with traumatic fractures admitted and treated in our hospital were selected as the research objects.The postoperative incision infection status and pathogen distribution of patients in the infection group were observed,and the drug resistance of major pathogens was analyzed.The levels of inflammatory factors and the predictive value of inflammatory factors in postoperative incision infection were compared between patients with and without postoperative incision infection,and the predictive value of inflammatory cytokines in postoperative incision infection was evaluated by using the area(AUC)under the receiver operator characteristics curve(ROC). Results A total of 23(7.42%)patients had postoperative incision infection.32 strains of pathogenic bacteria were isolated and cultured,including 18 strains of gram- negative bacteria,mainly pseudomonas aeruginosa,escherichia coli and acinetobacter baumannii,and 12 strains of gram- positive bacteria,mainly staphylococcus aureus,staphylococcus haemolyticus and staphylococcus epidermidis,and 2 strains of fungi,mainly candida albicans.The resistance rates of gram- negative bacteria to cefepime,ceftriaxone and ceftazidine were relatively strong,and the sensitivities of gram- negative bacteria to meropenem,imipenem and amitracin were relatively strong.Gram- positive bacteria were more resistant to penicillin and erythromycin,while staphylococcus aureus was more sensitive to tetracycline,and staphylococcus haemolyticus was more sensitive to levofloxacin.The levels of procalcitionin(PCT),interleukin(IL- 6),high- sensitivity C- reactive protein(hs- CRP)and erythrocyte sedimentation rate(ESR)in patients with postoperative incision infection were significantly higher than those in the non- infected group( P <0.05).The AUC values of ESR,hs- CRP,IL- 6 and PCT for postoperative incision infection were 0.810,0.873,0.917 and 0.854,respectively. Conclusion Postoperative incision infection in patients with traumatic fractures is mainly caused by gram- negative bacteria,followed by gram- positive bacteria.When administering antibacterial drugs to patients with incision infection,the rational use of antibacterial drugs should be strictly following the results of drug resistance tests.In addition,the level of inflammatory factors in patients with incision infection is significantly higher than that in patients without infection,which has certain predictive value for determining whether patients are infected with pathogens after the surgery.