大肠埃希菌定植对骨科手术部位感染的影响

Influence of colonization of Escherichia coli on surgical sife infection of orthopedics department

目的探究大肠埃希菌定植对骨科手术部位感染的影响。方法选取2017年3月-2018年3月华中科技大学同济医学院附属梨园医院骨科收治的患者118例为研究对象,根据是否发生大肠埃希菌定植分为试验组(大肠埃希菌定植)32例和对照组(无大肠埃希菌定植)86例;分析感染患者病原菌及耐药情况,并对感染患者和未感染患者手术部位感染(SSI)发生率、并发症发生率、白细胞(WBC)、中性粒细胞计数(NEUT%)、C-反应蛋白(CRP)、体温等指标进行分析;分析患者性别、年龄、住院时间、入住ICU及侵入性操作等资料,归纳大肠埃希菌定植对骨科手术患者感染的影响因素。结果试验组患者感染率和并发症发生率分别为46.88%(15/32)和68.75%(22/32)均高于对照组(P<0.05);且各类切口感染率高于对照组(P<0.05)。大肠埃希菌对常用抗菌药物耐菌率较高的是氨苄西林和一代头孢菌素类抗菌药物;而对亚胺培南、阿米卡星、呋喃妥因和头孢替坦较敏感;使用多种抗菌药物和合并慢性疾病是大肠埃希菌定植对患者骨科手术感染的影响因素(P<0.05)。结论大肠埃希菌定植发生时,骨科患者手术部位感染率和并发症发生率升高。因此在临床中应积极采取相应预防措施预防手术部位感染,降低感染发生率。

OBJECTIVE To explore the influence of colonization of Escherichia coli on surgical sife infection of orthopedics department.METHODS Totally 118 cases of patients treated in the department of orthopedics of LiYuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from Mar.2017 to Mar.2018 were enrolled.According to the occurrence of E.coli colonization,the patients were divided into experimental group(with E.coli colonization,32 cases)and control group(without E.coli colonization,86 cases).The pathogens and drug resistance of the infected patients were analyzed.The incidence of surgical site infection(SSI),incidence of complications,white blood cell(WBC),neutrophils count(NEUT),C-reactive protein(CRP)and body temperature of the infected and uninfected patients were analyzed.By analyzing the data of gender,age,length of stay in hospital,ICU admission and invasive operation,the factors influencing the infection of orthopedic operation patients with E.coli colonization were summarized.RESULTS The prevalence of infection and complications in the experimental group was 46.88%(15/32)and 68.75%(22/32)respectively,both were significantly higher than those in the control group(P<0.05).The infection rate of the incision was also significantly higher than that of the control group(P<0.05).The results of drug susceptibility showed that E.coli was the most resistant to ampicillin and the first-generation cephalosporin antibacterial drugs among the common antimicrobial agents.E.coli was relatively sensitive to imipenem,amikacin,nitrofurantoin and cefotetan.Use of multiple antimicrobial agents and complication with chronic diseases were influencing factors for infection of orthopedic operation patients with E.coli colonization(P<0.05).CONCLUSION The incidence of infection and the incidence of complications in surgery patients of orthopedics department were higher when E.coli colonization occurred.Therefore,we should take corresponding preventive measures to prevent surgical site infection and reduce the incidence of infection in clinical practice.