开放性下肢骨折患者发生创面感染的病原学及相关因素分析

Etiology and related factors of wound infection in patients with open lower limb fractures

目的探讨开放性下肢骨折患者发生创面感染的病原学分布及相关影响因素。方法选取2019年7月—2021年7月漯河市第三人民医院收治的136例开放性下肢骨折患者,根据是否发生创面感染分为感染组(n=32)和非感染组(n=104)。采用全自动微生物分析系统检测患者病原菌种类,收集并比较两组患者临床资料的差异,采用酶联免疫法检测两组患者降钙素原(PCT)、骨桥蛋白(OPN)及超氧化物歧化酶(SOD)水平,应用logistic回归性分析影响开放性下肢骨折患者发生创面感染的危险因素。结果32例创面感染患者中共检出42株病原菌,其中革兰氏阳性(G^(+))菌19株(46.34%)、革兰氏阴性(G^(-))菌22株(53.66%)及真菌1株(2.38%)。感染组抗菌药物使用时间、合并糖尿病、骨折至清创时间、骨折分度及住院时间与非感染组比较差异显著(P<0.05)。logistic回归性分析显示合并糖尿病、骨折至清创时间>6 h及住院时间≥3 d是影响开放性下肢骨折患者发生创面感染的独立危险因素(P<0.05)。感染组患者血清PCT及OPN水平高于非感染组,SOD水平低于非感染组(P<0.05)。结论开放性下肢骨折患者创面感染以G^(-)菌为主,其创面感染与是否合并糖尿病、骨折至清创时间及住院时间有关。

Objective To explore the etiological distribution and related influencing factors of wound infection in patients with open lower limb fractures.Methods A total of 136 patients with open lower limb fractures admitted to the hospital were enrolled between July 2019 and July 2021.According to presence or absence of wound infection,they were divided into infection group(n=32) and non-infection group(n=104).The types of pathogens were detected by full-automatic microbial analysis system.The differences of clinical data in the two groups were collected and compared.The levels of procalcitonin(PCT),osteopontin(OPN) and superoxide dismutase(SOD) in both groups were detected by enzyme-linked immunosorbent assay.The risk factors of wound infection in patients with open lower limb fractures were analyzed by logistic regression analysis.Results In the 32 patients with wound infection,there were 42 strains of pathogens,including 19 strains of Gram-positive(G^(+)) bacteria(46.34%),22 strains of Gram-negative(G^(-)) bacteria(53.66%) and 1 strain of fungus(2.38%).There were significant differences in usage time of antibiotics,diabetes mellitus,interval from fracture to debridement,fracture grading and hospitalization time between the two groups(P<0.05).logistic regression analysis showed that diabetes mellitus,interval from fracture to debridement >6h and hospitalization time ≥3d were independent risk factors of wound infection in patients with open lower limb fractures(P<0.05).The levels of serum PCT and OPN in infection group were higher than those in non-infection group,while SOD level was lower than that in non-infection group(P<0.05).Conclusion The main pathogen of wound infection is G~- bacteria in patients with open lower limb fractures.The wound infection is related to diabetes mellitus,interval from fracture to debridement and hospitalization time.