多中心慢性骨髓炎多重耐药菌感染的耐药特点及危险因素分析

Drug resistance and risk factors of multidrug-resistant organism in chronic osteomyelitis:a multi-center retrospective study

目的探讨慢性骨髓炎多重耐药菌(MDRO)感染的菌谱概况、耐药特点及危险因素。方法采取整群抽样方法,回顾性分析2016年1月至2021年12月期间山西医科大学第二人民医院骨科、山西省人民医院骨科、运城市中心医院骨科和临汾市人民医院骨科收治的414例慢性骨髓炎患者资料。根据是否检出MDRO分为两组:MDRO感染组150例,男118例,女32例;年龄(48.8±16.2)岁。非MDRO感染组264例,男194例,女70例;年龄(46.0±17.8)岁。描述并分析MDRO感染的菌谱特点及耐药性,比较两组患者的性别、年龄、病程、体重指数、入院前抗菌药物应用史、合并内科疾病、合并外伤及住院时间等临床资料,将P<0.05的项目纳入多因素logistic回归分析模型,探讨MDRO感染的危险因素。结果414例慢性骨髓炎患者中有286例检出病原菌,共331株。其中MDRO感染150例168株,检出率为50.8%(168/331)。168株MDRO中检出革兰阳性菌129株(76.8%,129/168),革兰阴性菌39株(23.2%,39/168)。金黄色葡萄球菌既是革兰阳性菌中检出率最高(58.1%,75/129)的菌种,也是本研究MDRO检出率最高(44.6%,75/168)的致病菌。革兰阳性菌对多肽类和恶唑烷酮类抗菌药物的耐药性较低(<10%)。多因素logistic回归分析结果显示:年龄≥45岁(OR=6.991,95%CI:3.525~13.865,P<0.001)、原发性高血压(OR=4.191,95%CI:2.070~8.485,P<0.001)、外伤(OR=4.232,95%CI:2.409~7.435,P<0.001)和住院时间长(OR=1.015,95%CI:1.001~1.029,P=0.030)是慢性骨髓炎患者MDRO感染的危险因素。结论MDRO检出率一直保持中高水平,以革兰阳性菌为主,对多数抗生素普遍耐药。以细菌培养为导向的抗生素治疗对慢性骨髓炎患者具有重大意义。年龄≥45岁、原发性高血压、外伤和住院时间长是慢性骨髓炎MDRO感染的危险因素。

Objective To investigate the spectrum,drug resistance and risk factors of multidrug resistant organism(MDRO)in chronic osteomyelitis.Methods A retrospective study was conducted by cluster sampling to analyze the 414 patients with chronic osteomyelitis who had been admitted to Department of Orthopaedics,The Second Hospital Affiliated to Shanxi Medical University,Department of Orthopaedics,The People's Hospital of Shanxi Province,Department of Traumatology,Yuncheng City Hospital,and Department of Orthopaedics,Linfen City Hospital from January 2016 to December 2021.The patients were assigned into 2 groups according to whether MDRO had been detected or not.In the MDRO infection group of 150 cases,there were 118 males and 32 females with an age of(48.8±16.2)years;in the non-MDRO infection group of 264 cases,there were 194 males and 70 females with an age of(46.0±17.8)years.The characteristics of bacterial spectrum and drug resistance in MDRO infection were described and analyzed.The 2 groups were compared in terms of clinical data like gender,age,course of disease,body mass index,history of antibiotic use before admission,combined internal diseases,combined trauma,and length of hospital stay.The items with P<0.05 were included in a multivariate logistic regression model to explore the risk factors for MDRO infection.Results Pathogenic bacteria(331 strains)were detected in 286 of the 414 patients with chronic osteomyelitis,and infection with 168 strains of MDRO was detected in 150 of the 286 patients,yielding a detection rate of 50.8%(168/331).Of the 168 strains of MDR,129(76.8%,129/168)were Gram-positive and 39(23.2%,39/168)Gram-negative.Staphylococcus aureus was the most frequently detected species of Gram-positive bacteria(58.1%,75/129)and the most frequently detected pathogen(44.6%,75/168)in this study.The resistance of Gram-positive bacteria to peptides and oxazolidinones was low(less than 10%).Multivariate logistic regression analysis showed that age≥45 years(OR=6.991,95%CI:3.525 to 13.865,P<0.001),essential hypertension(OR=4.191,95%CI:2.070 to 8.485,P<0.001),trauma(OR=4.232,95%CI:2.409 to 7.435,P<0.001)and length of hospital stay(OR=1.015,95%CI:1.001 to 1.029,P=0.030)were the risk factors for MDRO infection in patients with chronic osteomyelitis.Conclusions The detection rate of MDRO is at a medium to high level.Gram positive bacteria are the main pathogens and resistant to most antibiotics.Antibiotic therapy guided by bacterial culture is of great significance for patients with chronic osteomyelitis.Age≥45 years,essential hypertension,trauma,and long hospital stay are risk factors for MDRO infection in patients with chronic osteomyelitis.