采用循证医学对糖尿病患者骨科植入物手术感染控制的影响

发布时间：2018-02-01 12:34

本文关键词： 循证医学糖尿病骨科感染　出处：《中华医院感染学杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的探讨循证医学对糖尿病患者骨科手术植入物感染控制的影响。方法选取2013年1月-2015年12月于医院骨科行植入物的糖尿病患者682例为研究对象,分为循证医学组与对照组,每组341例;对照组采用常规医学模式,循证医学组在此基础上采用循证医学模式,对比两组患者手术植入物感染率、感染病原菌分布及耐药性。结果循证医学组糖尿病患者植入物感染率为4.7%显著低于对照组植入物感染率13.2%,差异有统计学意义(P0.05);61例糖尿病骨科手术植入物感染患者共分离病原菌71株,其中革兰阴性菌45株占63.4%,革兰阳性菌21株占29.6%,真菌5株占7.0%;革兰阴性菌主要为大肠埃希菌占25.4%,革兰阳性菌主要为凝固酶阴性葡萄球菌占14.1%;大肠埃希菌对庆大霉素、环丙沙星、氨苄西林等耐药性较高,分别为:83.3%、88.9%、100.0%,对美罗培南、亚胺培南、呋喃妥因等敏感,耐药性分别为:0.0%、0.0%、5.6%;凝固酶阴性葡萄球菌对氨苄西林/舒巴坦、头孢唑林、红霉素耐药性较高,分别为80.0%、80.0%、80.0%,对克林霉素、呋喃妥因、万古霉素等敏感,耐药性分别为:10.0%、0.0%、0.0%;金黄色葡萄球菌对氨苄西林/舒巴坦耐药性较高,为75.0%,对磺胺甲VA唑/甲氧苄啶、呋喃妥因、万古霉素较为敏感,耐药性分别为12.5%、12.5%,0.0%。结论将循证医学模式应用于糖尿病患者骨科植入术中,可显著降低植入物感染率。
[Abstract]:Objective to investigate the effect of evidence-based medicine on the infection control of implants in orthopaedic surgery of diabetic patients. Methods 682 patients with diabetes mellitus who underwent implants in orthopaedic department of hospital from January 2013 to December 2015 were studied. The object. The patients were divided into evidence-based medicine group (n = 341) and control group (n = 341). The patients in the control group were treated with the conventional medical model, and the patients in the evidence-based medicine group were treated with the Evidence-based medicine model. The infection rate of implants was compared between the two groups. Results the infection rate of implants in Evidence-based Medicine group (4.7%) was significantly lower than that in control group (13.22%), and the difference was statistically significant (P 0.05). A total of 71 strains of pathogenic bacteria were isolated from 61 cases of diabetic orthopedic surgery implants infection, of which 45 were Gram-negative bacteria (63.4B), 21 Gram-positive bacteria (29.6A), and 5 fungi (7.0strains). Gram-negative bacteria were mainly Escherichia coli and Gram-positive bacteria were coagulase-negative staphylococcus. Escherichia coli had higher resistance to gentamicin, ciprofloxacin and ampicillin, respectively, and was sensitive to meropenem, imipenem and furantoin. The drug resistance was 0. 0% and 0. 06%, respectively. Coagulase negative staphylococci had higher resistance to ampicillin / sulbactam, cefazolin and erythromycin, which were 80. 0% and 80. 0%, respectively, to clindamycin and furantoin. Vancomycin and others were sensitive, and the resistance to vancomycin was 0. 0% and 0. 0%, respectively. Staphylococcus aureus had higher resistance to ampicillin / sulbactam (75.0), and was sensitive to sulfamethoxazole / trimethoprim, furantoin and vancomycin (12.5%). Conclusion the application of evidence-based medicine in orthopedic implants of diabetic patients can significantly reduce the infection rate of implants.
【作者单位】：上海市第六人民医院东院感染管理科;上海市浦东新区光明中医医院骨科;上海市浦东医院防保科;上海市第六人民医院骨科;
【基金】：浦东新区卫生系统优秀青年医学人才培养计划(PWRQ2015-20)
【分类号】：R587.1;R687;R-03
【正文快照】： 4.上海市浦东医院防保科,上海201399)糖尿病是一种代谢性疾病,其发病的主要病症为高血糖,患者由于体内胰岛素合成障碍或其他生物功能损坏无法保持机体内血糖平衡,糖尿病会导致患者肾脏衰竭,对患者的生命安全产生巨大威胁。随着外科手术的不断发展,要求不断提高,各种不同型号、

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