骨科Ⅰ类切口手术部位感染病原菌分析

Analysis of pathogenic bacteria in orthopedic surgical site infection of class Ⅰ incision

目的对骨科Ⅰ类切口手术部位感染的病原菌进行分析研究,为临床合理运用抗生素和控制手术部位感染提供参考。方法回顾性分析我院2010年1月至2020年12月骨科Ⅰ类切口手术部位感染送检的150份标本检测结果,对病原菌分布和耐药性进行统计学分析。结果150份切口分泌物标本中122份培养出细菌,细菌培养阳性率81.33%,其中革兰阳性菌占68.85%,革兰阴性菌占31.15%。检出率最高的革兰阳性菌为金黄色葡萄球菌(62株),其次为溶血性葡萄球菌(9株)。金黄色葡萄球菌对环丙氟哌酸(10.71%)、左氧氟沙星(7.14%)、利福平(7.14%)耐药率较低。检出率最高的革兰阴性菌为阴沟肠杆菌(17株),其次为大肠埃希菌(9株),阴沟肠杆菌对左氧氟沙星、头孢他啶、阿米卡星尚无耐药菌株。结论骨科Ⅰ类切口手术部位感染的主要病原菌为金黄色葡萄球菌,其次为阴沟肠杆菌,在药敏报告出来前,可以选用耐药率较低的抗生素如喹诺酮类联合利福平进行抗感染治疗,然后根据药敏结果及时调整。

Background Surgical site infections(SSI)are infections that occur in incisions,deep organs,or cavities during the perioperative period of surgery and are among the most common nosocomial infections except for urinary tract infections,pneumonia infections,and blood infections.SSI will have a severe impact on the patient's health,and in extreme cases,it will even threaten the patient's life.In addition to the adverse effects on patients,SSI will also bring a substantial economic burden to the medical system.According to the statistical analysis of research data,superficial SSI treatment may be as high as 400 US dollars per case,while deep SSI treatment may be as high as 30000 US dollars per case.SSI after orthopedic surgery is a severe complication with an increased incidence and a heavy economic burden.SSI affects patients after orthopedic surgery despite the use of prophylactic antibiotics and surgical techniques and postoperative care improvements.Since the surgical incisions of orthopedic hospitalized patients are mainly type Ⅰ incisions(clean surgery),statistical analysis of the pathogen distribution and drug resistance rate of the SSI specimens submitted by orthopedic hospitalized patients with type Ⅰ incisions can provide a reference for clinical treatment and guide the rational use of antibacterial drugs.Objective To analyze the distribution characteristics of pathogens in orthopedic surgical site infection of class Ⅰ incision in our hospital from 2012 to 2020 and provide a reference for the rational use of antibiotics in clinical practice.Methods From 2012 to 2020,80 samples of SSI of class Ⅰ incision in the orthopedic department were collected,and the distribution of pathogenic bacteria and drug resistance rate were analyzed.Results Bacteria were cultured in 65 of the 80 incision secretions,and the positive rate of bacterial culture was 81.25%,of which Gram-positive bacteria accounted for 69.23%,and Gram-negative bacteria accounted for 30.77%.The highest detection rate of Gram-positive bacteria was Staphylococcus aureus(33 strains),followed by hemolytic Staphylococcus(5 strains).Staphylococcus aureus for ciprofloxacin(10.71%),levofloxacin(7.14%),and rifampicin(7.14%)have low resistance rates.The highest gram-negative bacteria were Enterobacter cloacae(9 strains),followed by Escherichia coli(5 strains).There were no resistant strains of Enterobacter cloacae to levofloxacin,ceftazidime or amikacin.Conclusions The major pathogen of orthopedic SSI in class Ⅰ incision is Gram-positive bacteria,mainly Staphylococcus aureus,which can be treated with antibiotics with low drug resistance before the results of bacterial culture and drug sensitivity are obtained to provide a reference for the rational use of antibiotics in clinical practice.