骨科门诊患者多重耐药菌感染的危险因素分析与防护对策

Analysis of risk factors and protective countermeasures of multi-drug resistant bacteria infection in patients of orthopaedic outpatient

目的探讨骨科门诊患者多重耐药菌感染危险因素与防护对策。方法回顾性分析2015年3月至2019年3月1935例骨科门诊感染患者的性别、年龄、所患疾病、合并基础病情况、抗生素应用情况、清创时间等临床资料,分析多重耐药菌感染的危险因素。结果经细菌培养,1935例骨科感染患者共有167例(8. 63%)感染多重耐药病原菌,其中革兰氏阳性菌感染率为50. 89%,革兰氏阴性菌感染率为47. 31%,真菌感染率为1. 80%;多因素logistic回归分析显示,年龄≥65岁、伤后到门诊就诊时间≥6 h、免疫力低下以及未预防性应用抗菌药物是导致多重耐药菌感染的独立危险因素(P <0. 05)。结论影响骨科门诊多重耐药菌感染的因素较多,应针对这些危险因素采取预防性措施,以避免多重耐药菌感染。

Objective To investigate the risk factors and protective countermeasures of multi-drug resistant bacteria infection in patients of orthopaedic outpatient. Methods To retrospectively analyze 1,935 cases of clinical data such as sex,age,disease,situation of combined underlying disease,antibiotic application,debridement time of orthopedic outpatients infected from March 2015 to March 2019. We analyzed the risk factors of multi-drug resistant infections. Results A total of 167 cases( 8. 63%) of multi-drug resistant pathogens were infected by bacterial culture in 1,935 cases. The infection rate of Gram-positive bacteria was 50. 89%,the infection rate of Gram-negative bacteria was 47. 31%,and the fungal infection rate was 1. 80%. Multivariate logistic regression analysis showed that the age ≥ 65 years,clinic time after an injury ≥ 6 h,low immunity and non-prophylactic antibacterial use were the independent risk factors for multi-drug resistant infection( P < 0. 05). Conclusion There were many factors affecting multi-drug resistant infection in orthopedic clinics. Preventive measures should be taken against these risk factors to avoid multi-drug resistant infection.