四肢骨折内固定术后切口感染病原菌特点及血清炎症因子水平

Etiological characteristics of incision infection and serum inflammatory cytokine levels in patients with limb fractures after internal fixation surgery

目的探讨四肢骨折内固定术后切口感染病原菌特点及血清白细胞介素-6(interleukin-6,IL-6)、白细胞介素-8(interleukin-8,IL-8)、降钙素原(procalcitonin,PCT)、C反应蛋白(creactive protein,CRP)水平。方法选取浙江省湖州市中心医院2016年1月—2017年12月骨科四肢骨折内固定手术患者2 480例,检测术后切口部位分泌物或脓液病原学及耐药性,检测术后血清IL-6、IL-8、PCT、CRP水平。根据是否发生术后切口感染分为感染组和未感染组。结果 2 480例四肢骨折内固定患者中,发生术后切口感染119例,感染率4.80%。119例术后切口感染患者共培养出病原菌151株。其中革兰阳性菌98株,革兰阴性菌47株,真菌6株。革兰阳性菌以金黄色葡萄球菌为主,占41.72%;革兰阴性菌以鲍氏不动杆菌、大肠埃希菌和肺炎克雷伯菌为主,分别占9.27%、8.61%和7.95%。金黄色葡萄球菌对红霉素、青霉素、苯唑西林耐药率高,耐药率分别为87.30%、84.13%和82.54%。鲍氏不动杆菌对头孢呋辛、头孢拉定、氨苄西林/舒巴坦、头孢唑啉、红霉素、阿米卡星、左氧氟沙星的耐药率均为100.00%;铜绿假单胞菌对头孢唑啉、米诺环素的耐药率均为100.00%;大肠埃希菌对头孢呋辛、米诺环素的耐药率均为100.00%。感染组血清IL-6、IL-8、PCT、CRP水平均高于未感染组(t=150.501、176.323、201.177、204.384,P均<0.05)。结论四肢骨折内固定术后切口感染病原菌主要为金黄色葡萄球菌、鲍氏不动杆菌、大肠埃希菌和肺炎克雷伯菌,感染病原菌耐药率较高,术后切口感染患者血清IL-6、IL-8、PCT、CRP水平升高。

Objective To describe the etiological characteristics of incision infection after internal fixation surgery in patients with limb fractures,and to determine the serum levels of interleukin-6(IL-6),interleukin-8(IL-8),procalcitonin(PCT)and C-reactive protein(CRP).Methods 2480 cases with limb fractures who underwent internal fixation surgery in Zhejiang hucheng central hospital from January 2016 to December 2017 were enrolled in the study and were divided into incision infection group(n=119)and uninfected group(n=2361).Postoperative incision secretion or pus were collected for pathogen identification and drug resistance test,blood samples were also collected after surgery to determine the serum levels of IL-6,IL-8,PCT and CRP.Results The overall postoperative incision infection rate was 4.80%.A total of 151 strains of pathogens were isolated,including 98 strains of gram-positive bacteria,47 strains of gram-negative bacteria and 6 strains of fungi.Staphylococcus aureus was the predominant gram-positive bacteria,accounting for 41.72%.While,Acinetobacter baumannii,Escherichia coli and Klebsiella pneumonia were the predominant gram-negative bacteria,accounting for 9.27%,8.61%,and 7.95%,respectively.Staphylococcus aureus was highly resistant to erythromycin,penicillin and oxacillin with the resistance rates of 87.30%,84.13%and82.54%.The resistance rates of Acinetobacter baumannii to cefuroxime,cephradine,ampicillin/sulbactam,cefazolin,erythromycin,amikacin and levofloxacin were 100.00%.The resistance rates of Pseudomonas aeruginosa to cefazolin and minocycline as well as E.coli to cefuroxime and minocycline were all 100.00%.The serum levels of IL-6,IL-8,PCT and CRP in the in the incision infection group were higher than those in the uninfected group(t=150.501,176.323,201.177,204.384,P<0.05).Conclusions Staphylococcus aureus,Acinetobacter baumannii,Escherichia coli and Klebsiella pneumoniae are predominant pathogens of incision infection after internal fixation surgery in patients with limb fractures,which are highly resistant to common antibiotics.Patients with postoperative incision infection usually have elevated serum levels of IL-6,IL-8,PCT and CRP.