骨科手术患者创口感染的病原菌分布特征及相关因素分析

Characteristics of pathogen distribution and factors related to infection in patients with an orthopedic surgical site infection

目的检测骨科手术患者创口感染的病原菌分布特征并分析其感染相关因素。方法 2017年1月-2019年4月本院骨外科收治的行骨科手术治疗患者134例,其中46例于术后出现创口感染的患者纳入观察组, 88例术后未发生感染患者纳入对照组,检测术后创口感染患者病原菌分布特征及耐药性;采用Logistic分析骨科手术患者术后创口感染的危险因素。结果 46例术后创口感染患者的标本中共检出52株病原菌,其中革兰阴性菌31株(占59.62%),主要为大肠埃希菌(12株,占23.08%)和阴沟肠杆菌(10株,占19.23%)。分离株大肠埃希菌对哌拉西林、亚胺培南、美罗培南、环丙沙星、阿米卡星、氨苄西林/舒巴坦的耐药率为0~40.00%,阴沟肠杆菌对头孢他啶、亚胺培南、美罗培南、环丙沙星、庆大霉素、阿米卡星的耐药率为0~40.00%。革兰阳性菌19株(占36.54%),主要为金黄色葡萄球菌(10株,占19.23%),对庆大霉素、复方磺胺甲恶唑、环丙沙星、左氧氟沙星、万古霉素、奎奴普丁/达福普丁、苯唑西林及呋喃妥因均的耐药率为0~30.00%;白假丝酵母2株(占3.84%),对复方磺胺甲恶唑、左氧氟沙星、万古霉素、奎奴普丁/达福普丁及呋喃妥因的耐药率均为0。经Logistic多因素分析,年龄≥60岁,侵入性操作,接台手术,手术部位在下肢或腰髋部,急诊手术,术后抗菌药物应用时间≥7d,有植入物等均为骨科手术患者术后感染的独立危险因素(P<0.05)。结论骨科术后创口感染的病原菌以革兰阴性菌大肠埃希菌等为主,且耐药性复杂。感染的高危因素包括年龄大、有侵入性操作、下肢或腰髋部手术、有植入物等,需要引起高度重视。

Objectives To examine the characteristics of pathogen distribution and infection-related factors in patients with a surgical site infection following orthopedic surgery.Methods Potential subjects were 134 patients treated by Orthopedics from January 2017 and April 2019;of those,46 with a surgical site infection after surgery served as the observation group,and 88 patients with no infection after surgery served as the control group.The characteristics of pathogen distribution and the drug resistance of the pathogens in patients with a surgical site infection were analyzed.Logistic analysis was used to analyze the risk factors for a surgical site infection in patients in Orthopedics.Results A total of 52 strains of pathogens were detected in 46 patients with a surgical site infection.Of those strains,31(59.62%)were strains of Gram-negative bacteria,including 12 strains of Escherichia coli(23.08%)and 10 strains of Enterobacter cloacae(19.23%).The resistance of Escherichia to piperacillin,imipenem,meropenem,ciprofloxacin,amikacin,and ampicillin/sulbactam ranged from 0-40.00%.The resistance of E.cloacae to ceftazidime,imipenem,meropenem,ciprofloxacin,gentamicin,and amikacin ranged from 0-40.00%.Nineteen strains(36.54%)of Gram-positive bacteria,mainly 10(19.23%)Staphylococcus aureus.Their resistance to gentamicin,sulfamethoxazole with trimethoprim,ciprofloxacin,levofloxacin,vancomycin,quinupristin/dalfopristin,oxacillin,and nitrofurantoin ranged from 0-30.00%.Two strains(3.84%)of the fungus Candida albicans were resistant to sulfamethoxazole with trimethoprim,levofloxacin,vancomycin,quinupristin/dalfopristin,and nitrofurantoin at a rate of 0.00%.Logistic multivariate analysis indicated that being≥60 years of age,invasive surgery,awaiting surgery,surgery on the lower limbs or lower back and hips,emergency surgery,duration of postoperative antibacterial application≥7 d,and receiving an implant are independent risk factors for a postoperative infection in patients in Orthopedics(P<0.05).Conclusion Gram-negative bacteria are the main pathogens causing a surgical site infection after orthopaedic surgery.The drug resistance of pathogens is complex.Risk factors for infection include age,invasive surgery,surgery on the lower limbs or lower back and hips,and receiving an implant.Close attention needs to be paid to these factors.