急诊严重胸外伤患者切口感染影响因素及病原学分析

发布时间：2018-03-09 09:50

本文选题：急诊　切入点：胸外伤　出处：《中华医院感染学杂志》2017年16期 　论文类型：期刊论文

【摘要】：目的探讨急诊严重胸外伤患者切口感染影响因素及病原学特征,为抗菌药物的合理应用及临床诊治提供依据。方法选择2013年5月-2016年5月于医院就诊的220例胸外伤患者,分析患者术后切口感染的病原菌分布及药敏;同时搜集患者的病例资料,分析发生切口感染的危险因素。结果 220例急诊严重胸外伤患者术后发生切口感染26例,感染率为11.82%;切口感染患者分泌物培养共分离出58株病原菌,其中革兰阴性菌35株,占60.34%,革兰阳性菌23株,占39.66%;主要革兰阴性菌依次为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌,分别占25.86%、15.52%和6.90%;主要革兰阳性菌依次为金黄色葡萄球菌和肺炎链球菌,分别占18.97%和10.34%;革兰阴性菌对青霉素类、喹诺酮类、第三代以下头孢菌素、四环素类、部分氨基糖苷类等抗菌药物耐药性较高,部分可达100.00%,而对碳青霉烯类、青霉素类+酶抑制剂、头孢菌素类+酶抑制剂及阿米卡星等仍然较敏感;革兰阳性菌对青霉素类、克林霉素等普遍耐药,但对部分头孢菌素类、万古霉素、替考拉宁、利福平、部分喹诺酮类等仍然较敏感;单因素分析结果显示,年龄、糖尿病病史、术中输血、切口类型、留置引流管、患者意识状态及静脉营养与患者术后发生切口感染具有相关性(P0.05);非条件Logistic多因素回归分析结果显示,年龄、糖尿病病史、切口类型及留置引流管是引起急诊严重胸外伤患者出现切口感染的独立危险因素(P0.05)。结论临床应重视对切口感染的监测,并针对引起急诊严重胸外伤患者合并切口感染的高危因素进行有效控制。
[Abstract]:Objective to investigate the influencing factors and etiological characteristics of incision infection in emergency patients with severe thoracic trauma, and to provide the basis for the rational use of antimicrobial agents and their clinical diagnosis and treatment. Methods 220 patients with thoracic trauma who were admitted to hospital from May 2013 to May 2016 were selected. The pathogenic bacteria distribution and drug sensitivity of postoperative wound infection were analyzed, and the data of patients were collected, and the risk factors of incision infection were analyzed. Results 26 cases of incision infection occurred after operation in 220 cases of emergency severe thoracic trauma. The infection rate was 11.82%. A total of 58 pathogenic bacteria were isolated from the secretion of patients with incision infection, of which 35 were Gram-negative bacteria (60.34), 23 were Gram-positive bacteria (39.66%), and the main gram-negative bacteria were Escherichia coli. Klebsiella pneumoniae and Pseudomonas aeruginosa accounted for 25.86% and 6.90%, respectively. The main gram-positive bacteria were Staphylococcus aureus and Streptococcus pneumoniae, accounting for 18.97% and 10.34 respectively. Gram-negative bacteria were penicillin, quinolones, and cephalosporins below the third generation. Tetracycline, some aminoglycosides and other antimicrobial agents were more resistant, some of them could reach 100.00g, but they were still sensitive to carbapenems, penicillin inhibitors, cephalosporins and amikacin. Gram-positive bacteria are generally resistant to penicillin and clindamycin, but still sensitive to some cephalosporins, vancomycin, teicoplanin, rifampicin, and some quinolones. Intraoperative blood transfusion, incision type, indwelling drainage tube, consciousness of patients and venous nutrition were correlated with postoperative wound infection (P 0.05). Non-conditional Logistic multivariate regression analysis showed that age, history of diabetes mellitus. The type of incision and indwelling drainage tube are the independent risk factors of incision infection in emergency patients with severe thoracic trauma. Conclusion the clinical monitoring of incision infection should be paid more attention to. The high risk factors of wound infection in emergency patients with severe thoracic trauma were effectively controlled.
【作者单位】：解放军第98医院急诊科;
【分类号】：R655

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