开放性骨折手术患者院内感染64例调查分析

Survey of 64 cases of nosocomial infection in patients undergoing open fractures

目的:探讨开放性骨折手术患者术后院内感染的相关因素。方法:选择2011年6月~2015年6月在医院接受手术治疗的753例开放性骨折患者,采集感染患者伤口脓液或血液、尿液、痰液等标本进行细菌培养、鉴定及药敏实验,并对术后感染的相关因素进行分析。结果:术后感染64例,感染率为8.50%。共检出109株病原菌,其中革兰阳性菌43株占39.45%,革兰阴性菌51株占46.79%,真菌15株占13.76%。主要革兰阳性菌对青霉素有较高的耐药率外,对亚胺培南、万古霉素、头孢曲松、头孢他啶、庆大霉素的耐药率<50%,尤其是对亚胺培南、万古霉素非常敏感。主要革兰阴性菌对青霉素具有较高的耐药率,均>80%,对头孢曲松、头孢他啶、庆大霉素的耐药率均<50%,而对亚胺培南、万古霉素很敏感。经logistic回归分析,年龄≥60岁、合并糖尿病、手术时间≥2h、出血量≥250ml、下肢或腰髋部手术、抗菌药物应用≥25d、住院时间≥40d、侵入性操作为开放性骨折手术患者院内感染的独立因素。结论:经调查分析年龄≥60岁、合并糖尿病、手术时间≥2h、出血量≥250ml、下肢或腰髋部手术、抗菌药物应用≥45d、住院时间≥40d、侵入性操作为开放性骨折手术患者院内感染的相关因素。根据相关因素积极采取相应的预防措施,以降低开放性骨折术后感染的发生率。

Objective To investigate the factors of open fractures of nosocomial infection after surgery.Methods June 2011--2015 in June hospital treated 753 cases of open fracture surgery patients,patients with infected wounds collection of pus or blood,urine,sputum and other samples for bacterial culture,identification and susceptibility testing,and postoperative risk factors for infection were analyzed.Results 64 cases of postoperative infection,the infection rate was 8.50%.109 were detected pathogens,including gram-positive bacteria 43 accounted for 39.45%,Gram-negative bacteria 51 accounted for 46.79%,accounting for 13.76% of fungi 15.Mainly Gram-positive bacteria resistant to penicillin have a higher rate,but to imipenem,vancomycin,ceftriaxone,ceftazidime,gentamicin resistance rate <50%,especially for imipenem South,very sensitive to vancomycin.Mainly Gram-negative bacteria resistant to penicillin have higher rates are> 80% for ceftriaxone,ceftazidime,gentamicin resistance rate <50%,while imipenem,vancomycin very sensitive.After logistic regression analysis,age ≥60 years,diabetes,surgery time ≥2h,bleeding ≥250ml,lower extremities or waist hip surgery,antimicrobial agents ≥25d,hospitalization ≥40d,invasive procedures in patients undergoing open fractures nosocomial infections independent factors.Conclusion The investigation and analysis of age ≥60 years,diabetes,surgery time ≥2h,bleeding ≥250ml,lower extremities or waist hip surgery,antimicrobial agents ≥45d,hospitalization ≥40d,invasive procedures in patients undergoing open fractures nosocomial infections related factors.Actively take appropriate preventive measures based on the relevant factors in order to reduce the incidence of infection after open fractures.