儿童股骨骨折医院内感染调查和病原菌检测结果分析

Investigation of nosocomial infection in children with femoral fractures and analysis of pathogens detection

目的分析儿童股骨骨折医院内感染的临床特点和病原学特征。方法回顾性分析本院2010年1月至2017年12月收治的138例股骨骨折患儿的临床资料,比较不同年份、季节、年龄、性别、住院天数的患儿医院内感染发生率的差异,分析医院内感染的发生部位、病原菌分布特点和主要病原菌耐药情况。结果138例股骨骨折患儿经确诊发生医院内感染15例(10.87%),共分离出20株病原菌,包括17株革兰氏阴性菌和3株革兰氏阳性菌,其中大肠埃希菌占比最高。不同年份、季节、年龄、性别患儿的医院内感染率比较差异均无统计学意义(均P>0.05);住院天数>14 d的患儿医院内感染率较高,不同住院天数患儿医院内感染率比较差异有统计学意义(P<0.05)。培养出的13株大肠埃希菌对氨苄西林、哌拉西林高度耐药,对亚胺培南、美罗培南和哌拉西林钠他唑巴坦钠高度敏感。结论儿童股骨骨折发生医院内感染风险可能与住院天数有关,病原菌主要为大肠埃希菌,临床可选择敏感抗生素进行针对性干预以防控感染。

Objective To analyze the clinical features and pathogenic features of nosocomial infection in children with femoral fracture.Method Clinical data of 138 children with femoral fracture treated in our hospital from January 2010 to December 2017 were analyzed retrospectively,the differences of nosocomial infection rates were compared among children with different years,seasons,ages,gender and hospital day.The occurrence sites of nosocomial infection,distribution features of pathogens and the resistance of main strains were analyzed.Result Among 138 cases of children with femoral fracture,15 cases(10.87%)were diagnosed with nosocomial infection,and 20 strains of pathogens were isolated,including 17 strains of Gram-negative bacteria and 3 strains of Gram-positive bacteria.And Escherichia coli accounted for the highest proportion.There were no significant differences in the infection rates among children with different years,seasons,ages and genders(all P>0.05).The infection rate was higher in children with hospital day>14 d,and there was a statistically significant difference in the infection rate at different hospital day(P<0.05).13 strains of Escherichia coli were highly resistant to Ampicillin and Piperacillin,and were highly sensitive to Imipenem,Meropenem and Piperacillin sodium and Tazobactam sodium.Conclusion The risk of nosocomial infection in children with femoral fractures can be related to the hospital day.The pathogen is mainly Escherichia coli,and sensitive antibacterial drugs for targeted interventions can be selected in clinical prevention and control of infection.