上肢开放性骨折术后感染病原菌及其耐药性

Drug resistance of pathogens in postoperative infection patients after open upper limb fractures

目的 探讨上肢部位开放骨折术后感染患者脓液病原菌及耐药特点。方法 选取2016年1月-2021年12月在天津市天津医院创伤上肢病区就诊的上肢部位开放骨折术后感染患者80例作为研究组,术后无感染患者240例作为对照组,对术后感染患者进行病原菌鉴定和药敏试验,同时分析研究组和对照组临床资料差异。结果 术后感染患者革兰阳性菌感染比例最高,占52.50%,其次为革兰阴性菌,占42.50%;金黄色葡萄球菌对青霉素、红霉素、苯唑西林和利福平耐药率较高,均超过80.00%;大肠埃希菌对头孢唑林耐药率高,超过90.00%;研究组年龄≥60岁、有糖尿病、手术时间≥2 h、伤后到院时间≥6 h、Gustilo分型ⅢC型、无预防性抗菌药物使用、血红蛋白(Hb)水平<110 g/L、白蛋白(ALB)水平<40 g/L、CD_(4)^(+)/CD_(8)^(+)<1比例高于对照组(P<0.05);Logistic回归分析结果显示:年龄、糖尿病、伤后到院时间、Gustilo分型、CD_(4)^(+)/CD_(8)^(+)是患者术后感染发生的影响因素(P<0.05)。结论 上肢部位开放骨折术后感染患者脓液病原菌以革兰阳性菌和革兰阴性菌为主,临床应参考药敏试验结果选取合适抗菌药物;术后感染受患者年龄、糖尿病、伤后到院时间、Gustilo分型、CD_(4)^(+)/CD_(8)^(+)影响,临床应加以重视。

OBJECTIVE To investigate the pathogenic bacteria and drug resistance of pus in patients with postoperative infection after surgery for open fracture of upper limb.METHODS From Jan 2016 to Dec 2021,80 patients with postoperative infection after open fracture of upper limb treated in Upper Limb Trauma Ward of Tianjin Hospital were enrolled as the research group,and 240 patients without postoperative infection were in the control group.Pathogen identification and drug sensitivity test were carried out in patients with postoperative infection,and the differences in the clinical data between the research group and control group were compared.RESULTS The infection rate of gram-positive bacteria was the highest,accounting for 52.50%,followed by gram-negative bacteria,accounting for 42.50%.The drug-resistant rates of Staphylococcus aureus resistance rate to penicillin,erythromycin,oxacillin and rifampicin were all higher than 80.00%.The drug resistance rate of Escherichia coli to cefazolin was more than 90.00%.In the research group,the proportions of patients with age≥60 years old,diabetes,operation time≥2 hours,time to hospital admission≥6 hours after injury,Gustilo classificationⅢC,no preventive antibiotic use,hemoglobin(Hb)level 110 g/L,albuminuria(ALB)level 40 g/L,CD_(4)^(+)/CD_(8)^(+)ratio1 in the study group were higher than those in the control group(P0.05).Logistic regression analysis showed that age,diabetes,time to hospital admission after injury,Gustilo classification,CD_(4)^(+)/CD_(8)^(+)ratio were the influencing factors for postoperative infection(P<0.05).CONCLUSION Gram-positive and gram-negative bacteria are the main pathogens in the pus of patients after surgery for an open fractures of the upper extremity.Appropriate antibiotics should be administered with reference to the drug susceptibility tests.Postoperative infection is affected by age,diabetes,time to hospital after injury,Gustilo classification,CD_(4)^(+)/CD_(8)^(+)ratio,so clinical attention should be paid to it.