骨科患者院内并发泌尿道感染的病原菌分布及危险因素分析

Analysis of pathogens distribution and risk factors of orthopaedic patients with urinary tract infection in hospital

目的分析骨科患者院内并发泌尿道感染的病原菌及其耐药性,对泌尿道感染发生的可能危险因素进行分析,以降低泌尿道感染的发生。方法采用回顾性分析方法,对某医院创伤骨科并发泌尿道感染患者相关临床资料、主要病原菌的耐药性以及感染发生的危险因素进行统计分析。结果625例骨科住院患者发生泌尿道感染48例,感染率7.68%,分离培养出病原菌53株,革兰阳性菌、革兰阴性菌和真菌的构成比分别为26.41%、66.04%和7.55%;革兰阴性菌以大肠埃希菌为主、革兰阳性菌以粪肠球菌为主、真菌以白色念珠菌最多见。大肠埃希菌对美罗培南和阿米卡星的耐药率较低,粪肠球菌对万古霉素的耐药率为0,对克林霉素耐药率>80.0%。多因素Logistic回归分析结果表明,年龄>65岁、入住ICU、住院时间超过30 d、留置导尿、留置导尿>7 d、多发骨折、急诊手术是骨科患者院内并发泌尿道感染的独立危险因素。结论骨科患者院内并发泌尿道感染的致病菌主要是大肠埃希菌,真菌往往以混合感染的形式出现,感染发生的危险因素较多,需针对性采取干预措施。

Objective To analyze the pathogens and their drug resistance of orthopaedic patients with urinary tract infection in hospital,and to analyze the possible risk factors of urinary tract infection to reduce the incidence of urinary tract infection.Methods A total of 625 patients who underwent treatment in three wards of a Hospital for two years were randomly selected to be grouped according to whether or not were accompanied by urinary tract infection.The pathogens in the infected group were counted and the drug resistance analysis of the main pathogens was carried out.The possible risk factors of infection were analyzed by logistic multiple regression.Results Of the 625 orthopaedic inpatients,48 cases had urinary tract infection and the infection rate was 7.68%.The urine specimens of infected patients were isolated and cultured.53 strains of pathogens were isolated,14 strains of Gram-positive bacteria accounted for 26.41%,35 strains of Gram-negative bacteria accounted for 66.04%,and 4 strains of fungi accounted for 7.55%;Gram-negative bacteria were mainly Escherichia coli,with 26 strains accounted for 49.06%;Gram-positive bacteria were mainly Enterococcus faecalis,with 9 strains accounted for 16.98%.The fungi Candida albicans are found in up to 3 strains,accounting for 5.66%.The resistance rate of Escherichia coli to meropenem and amikacin was low,and the resistance rate of Enterococcus faecalis to vancomycin was 0,and the resistance rate to clindamycin was>80.0%.Multivariate logistic regression analysis showed that age>65 years,admission to ICU,hospitalization time>30 d,indwelling catheterization,indwelling catheterization>7 d,multiple fractures,and emergency surgery were independent risk factors for urinary tract infections in orthopedic patients.Conclusion The pathogens of urinary tract infection in orthopedic patients are mainly Escherichia coli.Fungi often appears in the form of mixed infection.There are many risk factors for urinary tract infection in orthopedic patients.Actively taking appropriate prevention measures can reduce the incidence of infection.