骨外科患者术后切口感染病原菌与药敏及炎性因子分析

Pathogens and drug sensitivity of incisional infection in patients with bone surgery and analysis of and inflammatory factors

目的探讨骨外科患者术后切口感染病原菌与药敏及炎性因子分析。方法选择医院2013年1月-2017年12月收治的骨外科手术患者941例为研究对象,观察患者术后切口感染情况。采集患者切口感染部位标本,分离培养病原菌及进行药敏试验。采用速率散射比浊法测定超敏C-反应蛋白(hs-CRP)含量,采用Westergren试管测定法定量测定红细胞沉降率(ESR)含量,采用免疫化学发光法测定降钙素原(PCT)含量,采用酶联免疫吸附法测定肿瘤坏死因子-α(TNF-α)含量。结果骨外科患者术后切口感染率7.33%(69/941);关节骨科感染20例、脊柱骨科感染14例、创伤骨科感染35例。共培养分离病原菌78株,其中革兰阳性菌31株占39.74%,以金黄色葡萄球菌和溶血葡萄球菌为主;革兰阴性菌42株占53.85%,以铜绿假单胞菌和大肠埃希菌为主;真菌5株占6.41%。主要革兰阴性菌对头孢吡肟、头孢曲松和头孢他啶等的耐药性较强,对美罗培南和氨曲南较敏感;主要革兰阳性菌对青霉素和红霉素耐药性较强,未检出对万古霉素和替考拉宁耐药的菌株。切口感染患者血清hsCRP、ESR、PCT和TNF-α分别为(37.89±6.71)mg/L、(43.21±4.13)mm/h、(0.72±0.14)ng/mL和(19.48±4.31)ng/L高于未感染患者(P<0.001)。结论骨外科患者术后切口感染病原菌以革兰阴性菌为主;应严格按照耐药试验结果合理应用抗菌药物,感染患者炎性因子高于未感染患者,具有一定的临床价值。

OBJECTIVE To investigate the pathogens and drug sensitivity of incisional infection in patients with bone surgery and analyze the inflammatory factors.METHODS 941 patients which admitted to the hospital from Jan.2013 to Dec.2017 were enrolled in the study,and the postoperative infection of the patients was observed.The specimens of the infected site of the patients were collected,the pathogens were isolated and the drug sensitivity test was carried out.The content of hs-CRP was determined by rate scattering turbidimetry.The content of ESR was determined by Westergren test tube method.The content of PCT was detected by immunochemiluminescence assay and the content of TNF-αwas determined by ELISA.RESULTS Postoperative incision infection rate was 7.33%(69/941)in the patients with bone surgery.There were 20 cases of joint orthopedic infection,14 cases of spinal orthopedic infection and 35 cases of traumatic orthopedic infection.A total of 78 strains of pathogens were isolated,among which 31 strains were gram-positive bacteria(39.74%),mainly Staphylococcus aureus and Staphylococcus hemolyticus,42 strains were gram-negative bacteria(53.85%),mainly Pseudomonas aeruginosa and Escherichia coli,and 5 strains were fungi,accounting for 6.41%.The main gram-negative bacteria were relatively resistant to cefepime,ceftriaxone and ceftazidime,but were sensitive to meropenem and aztreonam.The main gram-positive bacteria were relatively resistant to penicillin and erythromycin,but no vancomycin and teicoplanin-resistant strains were detected.The serum levels of hs-CRP,ESR,PCT and TNF-a in patients with incisional infection were(37.89±6.71)mg/L,(43.21±4.13)mm/h,(0.72±0.14)ng/mL and(19.48±4.31)ng/L,higher than those of the uninfected patients(P <0.001).CONCLUSION Gram-negative bacteria are the main pathogens of incisional infection after orthopedic surgery.Antibiotics should be used reasonably according to the results of drug resistance test.Inflammatory factors of infected patients are higher than those of uninfected patients,which has certain clinical value.