老年全髋关节置换术后患者感染现状及其影响因素分析

Infection status and influencing factors thereof in elderly patients after total hip arthroplasty

目的探讨老年全髋关节置换术后患者感染现状及其影响因素。方法选取2015年1月—2019年12月在吉林大学第二医院行全髋关节置换术的老年患者411例为研究对象,根据术后医院感染情况将其分为感染组(23例)和未感染组(388例),记录感染部位,鉴定病原菌;比较两组患者临床资料,对存在差异的指标进行多因素Logistic回归分析。结果411例患者中23例(5.60%)发生医院感染,感染部位为呼吸道感染、泌尿系统感染、皮肤感染、血行感染的患者分别为11例(47.83%)、8例(34.78%)、2例(8.70%)、2例(8.70%)。23例医院感染患者中共检测出35株病原菌,其中大肠埃希菌9株(25.71%)、金黄色葡萄球菌7株(20.00%)、凝固酶阴性葡萄球菌7株(20.00%)、肺炎克雷伯菌6株(17.14%)、表皮葡萄球菌4株(11.43%)、粪肠球菌2株(5.71%)。相较于未感染组,感染组患者年龄较高,血红蛋白、白蛋白水平较低,手术时间及尿管滞留时间较长,术中出血量、异体输血及合并糖尿病患者比例较高(P<0.05)。多因素Logistic回归分析结果显示,年龄>75岁[OR^(^)=3.328(95%CI:1.727,8.414)]、合并糖尿病[OR^(^)=17.201(95%CI:1.201,36.352)]、手术时间>2 h[OR^(^)=6.424(95%CI:3.262,21.197)]、术中出血量>600 ml[OR^(^)=1.015(95%CI:1.005,10.025)]、异体输血[OR^(^)=12.026(95%CI:1.246,26.045)]、尿管滞留时间>48 h[OR^(^)=1.545(95%CI:1.178,12.028)]是老年全髋关节置换术后医院感染的危险因素(P<0.05);血红蛋白>100 g/L[OR^(^)=0.237(95%CI:0.086,6.652)]、白蛋白>28 g/L[OR^(^)=0.762(95%CI:0.615,9.944)]是其保护因素(P<0.05)。结论年龄、营养状况、合并糖尿病、手术时间、术中出血量、异体输血及尿管滞留时间与老年患者全髋关节置换术后医院感染关系密切。

Objective To investigate the infection status and influencing factors thereof in elderly patients after total hip arthroplasty.Methods Four hundred and eleven elderly patients who underwent total hip arthroplasty in our hospital from January 2015 to December 2019 were selected and divided into infection group(n=23)and non-infection group(n=388)according to postoperative infection status.The infection site was recorded and pathogenic bacteria were identified.The clinical data of the two groups were compared,and the indexes with differences between the groups were analyzed by multivariate Logistic regression.Results Among the 411 patients,23(5.60%)had nosocomial infection,of which 11(47.83%)had respiratory tract infection,8(34.78%)had urinary tract infection,2(8.70%)had skin infection,and 2(8.70%)had bloodstream infection.A total of 35 pathogenic bacteria were detected in 23 patients with infection,including 9 strains of Escherichia coli(25.71%),7 strains of Staphylococcus aureus(20.00%),7 strains of coagulase negative staphylococcus(20.00%),6 strains of Klebsiella pneumoniae(17.14%),4 strains of Staphylococcus epidermidis(11.43%)and 2 strains of Enterococcus faecalis(5.71%).Compared with the non-infection group,the infection group exhibited higher age,decreased levels of hemoglobin and albumin,longer durations of operation and urinary catheterization,more intraoperative blood loss and higher proportions of patients with allogeneic blood transfusion and diabetes mellitus(P<0.05).Multivariate Logistic regression analysis showed that age>75 years old[OR^(^)=3.328(95%CI:1.727,8.414)],diabetes mellitus[OR^(^)=17.201(95%CI:1.201,36.352)],operative duration>2 hours[OR^(^)=6.424(95%CI:3.262,21.197)],intraoperative blood loss>600 ml[OR^(^)=1.015(95%CI:1.005,10.025)],allogeneic blood transfusion[OR^(^)=12.026(95%CI:1.246,26.045)],duration of urinary catheterization>48 h[OR^(^)=1.545(95%CI:1.178,12.028)]were risk factors for nosocomial infection after total hip arthroplasty(P<0.05),and that hemoglobin>100 g/L[OR^(^)=0.237(95%CI:0.086,6.652)]and albumin>28 g/L[OR^(^)=0.762(95%CI:0.615,9.944)]were protective factors(P<0.05).Conclusions Age,nutritional status,diabetes mellitus,operative duration,intraoperative blood loss,allogeneic blood transfusion and duration of catheterization are closely related to nosocomial infection after total hip arthroplasty in elderly patients.