肱骨近端骨折患者手术部位感染病原菌分布特点及感染风险预测模型构建

Distribution characteristics of surgical site infection in patients with proximal humerus fracture

目的 探索肱骨近端骨折患者手术部位感染的病原菌分布特点、耐药性及感染风险预测模型构建。方法 回顾性分析2015年1月至2021年6月就诊的148例肱骨近端骨折患者资料,患者均进行病原菌分析、药敏检测,同时,统计肱骨近端骨折患者手术部位感染几率,根据患者是否感染分为两组,即未发生组(n=127,手术部位未发生感染),发生组(n=21,手术部位发生感染),经二元Logit回归分析影响患者手术部位感染的独立危险因素。结果 148例肱骨近端骨折患者,21例感染,其中以革兰阴性菌中大肠埃希菌(5株)最为常见,大肠埃希菌和铜绿假单胞菌对氨苄西林、氨苄西林-舒巴坦钠、阿莫西林耐药率较高。经二元Logistic回归模型分析,年龄>60岁(OR:8.778,95%CI:2.301~33.479)、受伤至入院时间>2 h(OR:4.398,95%CI:1.301~14.861)、急诊手术(OR:5.972,95%CI:1.769~20.157)、手术时间>120 min(OR:5.797,95%CI:1.657~20.275)、未合理使用抗菌药物(OR:5.281,95%CI:1.511~18.455)是影响肱骨近端骨折患者手术部位感染的独立危险因素。经Bootstrap法内验证,AUC为0.837,95%CI为0.769~0.906。结论 肱骨近端骨折患者手术部位感染主要以大肠埃希菌为主。而导致手术部位感染的因素为未合理使用抗菌药物、手术时间、急诊手术、受伤至入院时间、年龄,根据相关因素采取有效预防措施,可减少手术部位感染率。

Objective To explore the distribution characteristics of pathogen infection,drug resistance and infection risk prediction model in patients with proximal humerus fracture.MethodsThe data of 148 patients with proximal humerus fracture treated from January 2015 to June 2021 were retrospectively analyzed.Pathogenic bacteria analysis and drug sensitivity detection were performed for all patients.Patients were divided into two groups according to whether they were infected,namely,the non-occurrence group(n=127,no infection occurred at the surgical site)and the occurrence group(n=21,infection occurred at the surgical site).The independent risk factors of surgical site infection were analyzed by binary Logit regression.Results Among 148 patients with proximal humerus fracture,21 were infected,among which gram-negative Escherichia coli(5strains)was the most common.Escherichia coli and Pseudomonas aeruginosa had high resistance rates to ampicillin,ampicillin-sulbactam sodium and amoxicillin.After a binary Logistic regression model analysis,Age>60 years(OR:8.778,95%CI:2.301-33.479),the time from injury to hospital admission was>2 hours(OR:4.398,95%CI:1.301-14.861),emergency operation(OR:5.972.95%CI:1.769-20.157).operation time>120 min(OR:5.797,95%CI:1.657-20.275),antibiotics are not used properly(OR:5.281,95%CI:1.511 to 18.455)is an independent risk factor for surgical site infection in patients with proximal humerus fractures.According to Bootstrap verification,AUC was 0.837 and 95%CI was 0.769-0.906.Conclusion Patients with proximal humeral fracture mainly have E site infection.However,the factors leading to surgical site infection are not reasonable use of antibiotics,operation time,emergency surgery,time from injury to admission,and age.Taking effective preventive measures according to the relevant factors can reduce the rate of surgical site infection.