老年人工关节置换术后发生医院感染的临床特点及影响因素与预防探讨

Clinical characteristics and influencing factors of nosocomial infection in elderly patients after artificial joint replacement and its prevention

目的探究老年人工关节置换术后发生医院感染的临床特点及影响因素与预防。方法以本院2016年1月至2019年1月收治的214例老年人工关节置换术患者作为研究对象,统计医院感染发生情况,并分析医院感染病原学特点及相关危险因素。结果本次研究共随访214例老年人工关节置换患者,术后随访时间6~36个月,平均随访时间为(15.44±5.17)个月;其中19例发生医院感染,感染率为8.88%。19例患者共检出病原菌25株,其中革兰阳性菌占60.00%(15/25),革兰阴性菌占36.00%(9/25);病原菌以革兰阳性菌最多见。金黄色葡萄球菌对青霉素、克林霉素、阿米卡星等药物耐药性较高,对万古霉素的敏感性较高;表皮葡萄球菌对青霉素、红霉素等药物有很强的耐药性,对万古霉素的敏感性较高。铜绿假单胞菌对头孢呋辛、头孢替安具有较强的耐药性,对亚胺培南的敏感性较高;大肠埃希菌对头孢呋辛有较强的耐药性,对亚胺培南的敏感性较高。Logistics多因素回归分析,年龄(≥70岁)、糖尿病、手术时间(≥2 h)、术后引流时间(≥48 h)为老年人工关节置换术后发生医院感染的独立危险因素(P<0.05)。结论老年人工关节置换术后医院感染病原菌以革兰阳性菌多见,年龄(≥70岁)、糖尿病、手术时间(≥2 h)、术后引流时间(≥48 h)为老年人工关节置换术后发生医院感染的独立危险因素。

Objective To explore the clinical characteristics, influencing factors and prevention of nosocomial infection in elderly patients after artificial joint replacement. Methods A retrospective analysis of 214 elderly patients with artificial joint replacement treated in our hospital from January 2016 to January 2019 was made. The incidence of nosocomial infection was analyzed, and the etiological characteristics and related risk factors of nosocomial infection were analyzed.Results A total of 214 elderly patients with arthroplasty were followed up. The follow-up time was 6-36 months, with an average of(15.44±5.17) months. Among them, 19 cases had nosocomial infection, and the infection rate was8.88%. A total of 25 pathogenic bacteria were detected in 19 patients, of which 60.00%(15/25) were Gram-positive bacteria and 36.00%(9/25) were Gram-negative bacteria. Gram-positive bacteria were the most common pathogenic bacteria. Staphylococcus aureus had strong resistance to penicillin, clindamycin and amikacin, and high sensitivity to vancomycin. Staphylococcus epidermidis had strong resistance to penicillin and erythromycin, and high sensitivity to vancomycin. Pseudomonas aeruginosa had strong resistance to cefuroxime and cefotiam, and high sensitivity to imipenem.Escherichia coli had strong resistance to cefuroxime and high sensitivity to imipenem. Logistic multivariate regression analysis showed that age(≥70 years old), diabetes mellitus, operation time(≥2 h) and drainage time(≥48 h)were independent risk factors for nosocomial infection in elderly patients after artificial joint replacement(P<0.05). Conclusion Gram-positive bacteria are the most common pathogens of nosocomial infection in elderly patients after artificial joint replacement. Age(≥70 years old), diabetes mellitus, operation time(≥2 h) and drainage time(≥48 h) are the independent risk factors for nosocomial infection in elderly patients after artificial joint replacement.