骨折术后感染部位和菌株分布及其影响因素

Infection sites, species of pathogens and influencing factors for postoperative infection in fracture patients

目的研究骨折术后感染部位和菌株分布及感染影响因素。方法收集2016年12月-2018年12月解放军总医院收治的骨折术后感染和非感染患者,各124例。对骨折术后感染患者的感染发生部位进行统计分析。收集感染部位标本,用于细菌培养及药敏试验。采用单因素和多因素Logistic回归方法,分析感染的影响因素。结果 124例骨折术后感染患者感染部位以表浅切口为主(45.16%),共培养分离病原菌153株,其中革兰阴性菌115株(75.16%),以鲍氏不动杆菌39株(25.49%)和铜绿假单胞菌36株(23.53%)多见;革兰阳性菌38株(24.84%),以金黄色葡萄球菌28株(18.30%)多见。鲍氏不动杆菌对哌拉西林耐药率最高,对头孢哌酮耐药率最低;铜绿假单胞菌对庆大霉素耐药率最高,对左氧氟沙星耐药率最低;金黄色葡萄球菌对氨苄西林耐药率最高,对利奈唑胺耐药率最低。骨折分型、手术次数、手术时间是患者骨折术后感染的独立影响因素(P<0.05)。结论骨折分型、手术次数、手术时间是患者骨折术后感染的独立影响因素,骨折术后感染患者感染部位以表浅切口为主,病原菌以革兰阴性菌为主,呈现多药耐药性,因此临床应适当减少手术次数、缩短手术时间等,并合理使用抗菌药物,以防止骨折术后感染,减少患者痛苦及负担。

OBJECTIVE To investigate the infection sites, species of pathogens and influencing factors for postoperative infection in fracture patients. METHODS Totally 124 fracture patients with postoperative infection and 124 fracture patients without postoperative infection who were treated in the Chinese PLA Hospital from Dec 2016 to Dec 2018 were enrolled in the study. The infection sites of the fracture patients with postoperative infection were statistically analyzed. The specimens were collected from the infection sites, the bacterial culture and drug susceptibility testing were carried out, and the univariate analysis and multivariate logistic regression analysis were performed for influencing factors for the infection. RESULTS The patients with superficial incision infection were dominant among the 124 fracture patients with postoperative infection, accounting for 45.16%. A total of 153 strains of pathogens were isolated, of which 115(75.16%) were gram-negative bacteria, and 38(24.84%) were gram-positive bacteria;Acinetobacter baumannii(39 strains, 25.49%) and Pseudomonas aeruginosa(36 strains, 23.53%) were the predominant species of the gram-negative bacteria;Staphylococcus aureus(28 strains, 18.30%) was dominant among the gram-positive bacteria. The drug resistance rate of the A.baumannii strains to piperacillin was the highest, while the drug resistance rate to cefoperazone was the lowest;the drug resistance rate of the P.aeruginosa strains to gentamicin was the highest, while the drug resistance rate to levofloxacin was the lowest. The drug resistance rate of the S.aureus strains to ampicillin was highest, while the drug resistance rate to linezolid was lowest. The types of fracture, number of times of surgery and operation duration were the independent influencing factors for the postoperative infection in the fracture patients(P<0.05). CONCLUSION The types of fracture, number of times of surgery and operation duration are the independent influencing factors for the postoperative infection in the fracture patients. The superficial incision is the predominant infection site of the fracture patients with postoperative infection. The gram-negative bacteria are dominant among the pathogens and show multidrug-resistant, therefore, it is necessary for the hospital to reduce the number of times of surgery, shorten the operation duration and reasonably use antibiotics so as to prevent the postoperative infection and relieve the pain and burden of the fracture patients.