毒蛇咬伤创面感染的病原学特点及影响因素分析

Analyzed on etiological characteristics and influencing factors of snakebite wound

目的研究毒蛇咬伤创面感染的病原学特点,分析其影响因素。方法回顾性分析2017年1月~2019年6月在我院行手术治疗的186例毒蛇咬伤患者的临床资料,包括年龄、咬伤后救治时间、使用抗蛇毒血清、使用预防性抗菌药物、白细胞计数、C-反应蛋白、白蛋白、血清基质金属蛋白酶-9、可溶性细胞间黏附分子-1等。将毒蛇咬伤患者根据感染诊断标准分为感染组与非感染组。先排查病例资料的单因素,再运用多因素logistic回归分析毒蛇咬伤创面感染的影响因素。结果 186例蛇毒咬伤患者中,有43例(23.12%)创口感染,共分离培养病原菌56株,其中革兰阴性菌31株,占55.36%,主要为大肠埃希菌与铜绿假单胞菌;革兰阳性菌22株,占39.29%,以金黄色葡萄球菌、溶血链球菌为主。单因素分析发现,感染组患者使用抗蛇毒血清、使用预防性抗菌药物、CRP、MMP-9、sICAM-1与非感染组比较,差异均有统计学意义(均P<0.05);Logistic回归分析发现,使用抗蛇毒血清、使用预防性抗菌药物、CRP≥30.23 mg/L、MMP-9≥4.12μg/L、sICAM-1≥3214.58 ng/L是毒蛇咬伤创面感染的影响因素,差异均有统计学意义(均P<0.05)。结论使用抗蛇毒血清、使用预防性抗菌药物、CRP≥30.23 mg/L、MMP-9≥4.12μg/L、sICAM-1≥3214.58 ng/L是毒蛇创面感染的影响因素,加强针对影响因素实施干预措施,降低创面感染的发生率,有利患者早日康复。

Objective To study the etiological characteristics of venomous snakebite wound infection and analyze its influencing factors. Methods The clinical data(including age,treatment time after bite,use of antivenin,use of prophylactic antibiotics,white blood cell count,C-reactive protein,albumin,serum matrix metalloproteinase 9,soluble intercellular adhesion molecule 1,etc) of 186 patients with venomous snake bite who underwent surgical treatment in our hospital from January 2017 to June 2019 were retrospectively analyzed.Snakebite patients were divided into infected group and non-infected group according to the diagnostic criteria of infection.Univariate factors of patients’ data were screened first,and then multivariate logistic regression was used to analyze the influencing factors of venomous snakebite wound infection. Results 43 of the 186 snakebite patients(23.12%) had wound infection.A total of 56 pathogenic bacteria were isolated and cultured,among which 31 were gram-negative bacteria,accounting for 55.36%,mainly escherichia coli and pseudomonas aeruginosa.Gram-positive bacteria were 22 strains,accounting for 39.29%,mainly staphylococcus aureus and streptococcus haemolyticus.Univariate analysis showed that there were statistically significant differences in the use of antivenin,prophylactic antibiotics,CRP,MMP9 and sICAM1 between the infected group and the non-infected group(allP<0.05).Logistic regression analysis showed that the use of antivenom,the use of prophylactic antibacterial agents,CRP≥30.23 mg/L,MMP9≥4.12 g/L,sICAM1≥3214.58 ng/L were the influencing factors for venomous snakebite wound infection,with statistically significant differences(allP<0.05). Conclusion The use of antivenin,the use of prophylactic antibacterial agents,CRP≥30.23 mg/L,MMP9≥4.12 g/L,sICAM1≥3214.58 ng/L are the influencing factors for wound infection of snakebite.To strengthen the implementation of intervention measures for influencing factors,reduce the incidence of wound infection,is conducive to the early recovery of patients.