骨科植入术后医院感染病原菌特点及危险因素分析

发布时间：2018-06-03 07:39

  本文选题：骨科植入 + 医院感染　； 参考：《中华医院感染学杂志》2017年18期

【摘要】：目的探讨骨科植入术后医院感染病原菌特点及危险因素分析。方法选择医院于2014年12月-2016年12月收治的行骨科植入术患者1437例。采集患者痰液、尿液、血液标本,分离培养细菌,其中革兰阳性菌药敏试验采用GN201法,革兰阴性菌药敏试验采用GP法,以纸片扩散法进行药敏试验。回顾性分析患者临床资料,内容包括性别、年龄、手术类型、气压止血时间、术中应用大功率电刀、术后PVP碘纱布贴伤口。结果骨科植入术患者1437例,术后发生医院感染患者66例,感染率为4.59%;66例术后医院感染患者中,30例发生切口感染占45.45%;呼吸道感染16例占24.24%,泌尿道感染12例占18.18%,其他8例占12.12%;术后医院感染66例患者共分离培养病原菌80株,其中革兰阴性菌48株占60.00%,革兰阳性菌30株占37.50%,真菌2株占2.50%;主要革兰阴性菌铜绿假单胞菌对阿莫西林和头孢曲松耐药率较高,分别为90.48%和80.95%;鲍氏不动杆菌对阿莫西林、美罗培南、头孢他啶、阿米卡星等耐药率较高,分别为91.67%、8.33%、83.33%、75.00%;主要革兰阳性菌金黄色葡萄球菌对青霉素、红霉素、环丙沙星耐药率较高,分别为100.00%、85.71%、78.57%;表皮葡萄球菌对红霉素和青霉素耐药率较高,分别为100.00%和90.91%;单因素分析表明,性别、年龄、手术类型比较差异无统计学意义(P0.05);气压止血时间≥90min、术中应用大功率电刀及术后PVP碘纱布贴伤口具有统计学差异(P0.05);将单因素分析中具有统计学差异的纳入多因素分析表明,气压止血时间≥90min、术中应用大功率电刀及术后PVP碘纱布贴伤口为术后发生医院感染的独立危险因素。结论骨科植入术后医院感染患者以手术切口感染为主,病原菌以革兰阴性菌为主,气压止血时间≥90min、术中应用大功率电刀及术后PVP碘纱布贴伤口为术后发生医院感染的危险因素,应合理应用抗菌药物及针对危险因素采取相应预防措施。
[Abstract]:Objective to investigate the characteristics and risk factors of nosocomial infection after orthopedic implantation. Methods 1437 orthopaedic implants were selected from December 2014 to December 2016. The sputum, urine and blood samples of patients were collected and the bacteria were isolated and cultured. The drug sensitivity test of Gram-positive bacteria was performed by GN201 method, the susceptibility test of Gram-negative bacteria by GP method, and the drug sensitivity test by disk diffusion method. The clinical data of the patients were analyzed retrospectively, including sex, age, type of operation, time of pneumatic hemostasis, application of large power electric knife during operation and application of PVP iodine gauze after operation. Results there were 1437 cases of orthopedic implants and 66 cases of postoperative nosocomial infection. The infection rate was 4.590.30 of 66 patients with postoperative nosocomial infection had incision infection (45.45%), 16 patients had respiratory tract infection (24.24cm), 12 patients had urinary tract infection (18.1818) and the rest 8 patients (12.12%), 66 patients with postoperative nosocomial infection had isolated and cultured 80 strains of pathogenic bacteria. Among them, 48 strains of Gram-negative bacteria accounted for 60.00m, 30 strains of Gram-positive bacteria accounted for 37.50, 2 strains of fungi accounted for 2.50.The resistance rates of the main gram-negative bacteria Pseudomonas aeruginosa to amoxicillin and ceftriaxone were 90.48% and 80.95%, respectively, and Acinetobacter baumannii to amoxicillin, The drug resistance rates of meropenem, ceftazidime and amikacin were 91.67 and 8.33 and 83.33, respectively. The main gram-positive bacteria Staphylococcus aureus showed higher resistance to penicillin, erythromycin and ciprofloxacin. The resistance rates of Staphylococcus epidermidis to erythromycin and penicillin were 100.00% and 90.91%, respectively. There was no significant difference in the type of operation (P 0.05), the time of hemostasis was more than 90 min, the application of high power electric knife during operation and the application of PVP iodine gauze to the wound after operation had statistical difference (P 0.05), and the multivariate analysis showed that there were statistical differences in single factor analysis. The blood pressure hemostasis time was more than 90 min, the application of high-power electric knife and postoperative PVP iodine gauze sticking wound were the independent risk factors of nosocomial infection. Conclusion the nosocomial infection after orthopedic implantation is mainly caused by incision infection and Gram-negative bacteria. The hemostasis time of air pressure 鈮，

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