膝关节骨性关节炎患者术后感染病原菌分布耐药性以及影响因素分析

Distribution of Pathogenic Bacteria,Drug Resistance and Factors Influencing Postoperative Infection in Patients with Osteoarthritis of the Knee Joint

目的:调查2016年至2020年石家庄市第三医院膝关节骨性关节炎患者术后假体周围感染病原菌分布、耐药性以及影响因素分析。方法:选择2016年1月至2020年1月石家庄市第三医院收治的1509例行膝关节手术的膝关节骨性关节炎患者,根据术后是否发生感染将患者分为感染组(38例)和未感染组(1471例)。采集感染者膝关节腔积液并培养,检测病原菌种类以及耐药性。收集临床资料,采用多因素Logistic回归分析影响膝骨性关节炎患者术后假体周围感染的因素。结果:共检出46株病原菌,其中革兰氏阳性菌占86.96%,革兰氏阳性菌对β-内酰胺类、喹诺酮类等多数抗生素耐药。手术时间≥3h、2型糖尿病、类风湿性关节炎、吸烟、术后尿路感染、未使用抗生素预防是膝关节骨性关节炎患者术后假体周围感染的危险因素(P<0.05)。结论:膝关节骨性关节炎术后假关节周围感染病原菌以革兰氏阳性菌为主,且耐药率高。手术时间过长、合并2型糖尿病、类风湿性关节炎、吸烟、术后并发尿路感染以及未使用抗生素预防感染是导致假关节周围感染的主要因素,应加强对高危患者感染监测,合理使用抗生素,以降低感染风险。

Objective:To investigate the distribution of pathogenic bacteria,drug resistance and influencing factors of postoperative pseudojoint infection in patients with knee osteoarthritis in Shijiazhuang Third Hospital from 2016 to 2020.Methods:Totally 1509 patients with knee osteoarthritis who underwent knee surgery in Shijiazhuang Third Hospital from January 2016 to January 2020 were selected and divided into infection group(38 cases)and non-infection group(1471 cases)according to postoperative infection.The knee joint effusion of the infected patients was collected and cultured to detect the types of pathogenic bacteria and drug resistance.Clinical data were collected and multivariate Logistic regression was used to analyze the factors influencing postoperative infection in patients with knee osteoarthritis.Results:A total of 46 strains of pathogenic bacteria were detected,of which 86.96%were Gram-positive bacteria,Gram-positive bacteria were resistant toβ-lactam,quinolones and other antibiotics.Duration of operation≥3h,type 2 diabetes,rheumatoid arthritis,smoking,postoperative urinary tract infection and prevention without antibiotics were risk factors for postoperative periprosthetic infection in patients with knee osteoarthritis(P<0.05).Conclusion:Gram-positive bacteria are the main pathogenic bacteria of pseudojoint infection after knee osteoarthritis,and have high drug resistance rate.Long operation time,type 2 diabetes mellitus,rheumatoid arthritis,smoking,postoperative urinary tract infection and failure to use antibiotics to prevent infection are the main factors leading to infection around pseudarthrosis.Infection monitoring of high-risk patients should be strengthened and antibiotics should be rationally used to reduce the risk of infection.