股骨粗隆间骨折患者创口感染病原菌分布、药敏性及干预对策研究

Study on distribution,drug sensitivity and intervention strategies of pathogenic bacteria in patients with femoral intertrochanteric fracture

目的探讨老年股骨粗隆间骨折患者创口感染分泌物病原菌分布调查、药敏性特征及相关干预对策。方法将2016年10月-2019年3月本院收治的173例老年股骨粗隆间骨折患者作为观察对象,统计患者创口感染率;采集创口感染分泌物,开展常规病原菌培养和分离试验、药敏实验,分析创口感染病原学特点和药敏性。结果173例老年股骨粗隆间骨折患者并发创口感染66例,感染率为38.15%;66例创口感染患者共分离出145株病原菌,包括57株革兰阴性菌和75株革兰阳性菌、13株真菌;大肠埃希菌对左氧氟沙星、氨苄西林、环丙沙星和磺胺甲恶唑/甲氧苄啶存在高度耐药性;铜绿假单胞菌对左氧氟沙星、氨苄西林、氨苄西林/舒巴坦、磺胺甲恶唑/甲氧苄啶和头孢唑林存在高度耐药性,但对哌拉西林/他唑巴坦、妥布霉素无耐药性;金黄色葡萄球菌对红霉素、青霉素G、克林霉素和氨苄西林/舒巴坦存在高度耐药性;凝固酶阴性葡萄球菌对青霉素G和氨苄西林/舒巴坦存在高度耐药性,耐药率均为100.00%,但对万古霉素、替考拉宁无耐药性。结论老年股骨粗隆间骨折患者创口感染分泌物病原菌分布主要为革兰阳性菌,如金黄色葡萄球菌等,对亚胺培南、美罗培南、万古霉素、替考拉宁等相关抗菌药物无耐药性,故于防控骨折创口感染过程中,可给予患者敏感抗菌药物治疗,强化健康宣教,以减少创口感染,保证临床疗效。

Objective To investigate the distribution of pathogenic bacteria in wound infection and secretion in elderly patients with intertrochanteric fractures,the characteristics of drug sensitivity and related intervention strategies.Methods From October 2016 to March 2019,173 cases of elderly patients with intertrochanteric fractures were enrolled in this hospital.The infection rate of patients was counted,wound infections were collected and routine pathogen culture and separation tests were conducted.Experiments were conducted to analyze the pathogenic characteristics and drug sensitivity of wound infection.Results Among the 173 elderly patients with intertrochanteric fractures,66 were infected with wound infection,and the infec-tion rate was 38.15%.A total of 145 pathogens were isolated from 66 cases of patients with wound infection,including 57 Gram-negative bacteria and 75 Gram-positive bacteria.Escherichia coli is highly resistant to levofloxacin,ampicillin,cipro-floxacin and sulfamethoxazole/trimethoprim;Pseudomonas aeruginosa to levofloxacin,ampicillin,ampicillin/sulbactam,sulfa-methamine Oxazole/trimethoprim and cefazolin are highly resistant,but not resistant to piperacillin/tazobactam and tobramycin;Staphylococcus aureus is highly resistant to erythromycin,penicillin G,clindamycin and ampicillin/sulbactam;Coagulase-negative staphylococci were highly resistant to penicillin G and ampicillin/sulbactam,and the drug resistance rate was 100.00%,but it was not resistant to vancomycin and teicoplanin.Conclusion The distribution of pathogenic bacteria in wound infection secretions of elderly patients with intertrochanteric fractures is mainly Gram-positive bacteria,such as Staphy-lococcus aureus,etc.It is intolerant to imipenem,meropenem,vancomycin,teicoplanin and other related antibacterial drugs;therefore,in the process of preventing and controlling fracture wound infection,patients can be given sensitive antibacterial drug treatment to strengthen health education,reduce wound infection and ensure clinical efficacy.