老年创伤性肢体骨折患者术后伤口感染的危险因素分析及病原菌分布

Analysis of Risk Factors and Pathogen Distribution of Postoperative Wound Infection in Elderly Patients with Traumatic Limb Fractures.

目的探讨老年创伤性肢体骨折患者术后伤口感染的危险因素和病原菌分布。方法回顾性分析2016年1月至2021年5月我院骨科中心收治的180例老年创伤性肢体骨折患者临床资料,根据术后有无伤口感染,分为感染组(38例)和非感染组(142例),对感染组伤口分泌物行细菌培养及药敏试验,并通过单因素和多因素Logistic回归分析伤口感染的独立危险因素。结果革兰阳性菌为老年创伤性肢体骨折术后伤口感染的主要致病菌(63.8%),其主要以金黄色葡萄球菌(31.9%)、表皮葡萄球菌(17.0%)为主。药敏试验结果显示主要病原菌对青霉素、阿莫西林及头孢唑林等耐药率较高(耐药率>50.0%);对万古霉素和亚胺培南较敏感(耐药率0~6.7%)。单因素分析显示,两组在合并糖尿病、长期激素使用史、术前白蛋白水平、骨折类型、清创次数、手术时间、术中出血量等方面,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,合并糖尿病、激素使用时间≥3个月、开放性骨折、清创次数<2次、术中出血量≥500 ml为老年创伤性肢体骨折术后伤口感染发生的独立危险因素。结论老年创伤性肢体骨折术后伤口感染以革兰阳性菌为主,应根据药敏试验结果选择合理抗生素,同时针对危险因素,采取综合防治措施,降低老年创伤性肢体骨折术后伤口感染的发生率。

Objective To explore the risk factors of wound infection and distribution of pathogenic bacteria in elderly patients with traumatic limb fractures.Methods The clinical data of 180 elderly patients with traumatic limb fractures admitted to the Orthopedics Center of Suining Central Hospital from January 2016 to May 2021 were retrospectively analyzed.Depending on postoperative wound infection,they were divided into infected group(38 cases)and non-infected group(142 cases).Bacterial culture and drug sensitivity tests were performed on wound secretions in the infected group,and the independent risk factors of wound infection were analyzed by univariate and multivariate logistic regression.Results Gram-positive bacteria was the main pathogenic bacteria(63.8%)of wound infection after traumatic limb fractures in the elderly and they were mainly Staphylococcus aureus(31.9%),Staphylococcus epidermidis(17.0%).The results of the drug susceptibility test showed that the main pathogens had high resistance rates to penicillin,amoxicillin,and cefazolin(resistance rate>50.0%);they were more sensitive to vancomycin,imipenem(resistance rate 0~6.7%).Univariate analysis showed that there were statistically significant differences between the two groups in terms of combined diabetes mellitus,long-term hormone use history,preoperative albumin level,fracture type,number of debridement,operation time,intraoperative blood loss,etc(P<0.05).Multivariate logistic regression analysis showed that diabetes mellitus,hormone use history≥3 months,open fractures,debridement times<2 times,intraoperative blood loss≥500 ml were independent risk factors of wound infection after traumatic limb fractures in elderly patients.Conclusion Wound infections in elderly traumatic limb fractures are mainly gram-positive bacteria.Reasonable antibiotics should be selected based on drug susceptibility tests.At the same time,comprehensive prevention and treatment measures should be taken for risk factors to reduce the incidence of postoperative wound infections of elderly traumatic limb fractures.