人工关节置换手术感染及控制措施分析  

Postoperative infections in patients undergoing artificial joint replacement surgery and prevention and control measures

作　　者：孙文才[1] 辛兆旭[1] 白玉江[1] 

机构地区：[1]齐齐哈尔医学院附属第三医院骨科,黑龙江齐齐哈尔161000

出　　处：《中华医院感染学杂志》2014年第6期1469-1470,1473,共3页Chinese Journal of Nosocomiology

基　　金：黑龙江省教育厅基金资助项目(11531432)

摘　　要：目的研究人工关节置换手术后感染、病原菌及耐药率,并分析控制人工关节置换手术后感染的对策。方法选取医院2010-2012年医院手术患者286例,对发生感染的患者留取不同部位的标本采用BACTEC9050培养系统分离培养病原菌,依据NCCLS指定的K-B琼脂法进行药敏试验,药敏结果判定严格按照NCCLS进行,采用SPSS13.0软件进行统计分析。结果 2010年8月-2012年8月在医院进行人工置换关节手术的患者共286例,其中发生感染96例,感染率33.6%;96例感染患者经分离培养出病原菌112株,革兰阳性菌49株占43.75%,革兰阴性菌63株占56.25%;人工关节置换手术后感染的主要革兰阳性病原菌对替莫唑胺、林可霉素和替考拉宁的耐药率较低,均<10.00%;主要革兰阴性菌对亚胺培南和万古霉素的耐药率较低,均<10.00%。结论人工关节置换手术后感染的发生率高,且多为多药耐药菌感染,临床应采取措施控制感染的发生,如若发生人工关节置换手术后感染,首先应分离培养病原菌并进行药敏试验,选取耐药率低的药物进行及时有效的治疗。OBJECTIVE To study the distribution and drug resistance of pathogens causing postoperative infections in patients undergoing the artificial joint replacement surgery and put forward the corresponding measures for control of the postoperative infections. METHODS A total of 286 patients who underwent surgery in the hospital from 2010 through 2012 were enrolled in the study, then the specimens were sampled from various sites of the patients with infections, the isolation and culture of pathogens were performed with the use of BACTEC 9050 culture system, the drug susceptibility testing was conducted by using K-B method specified by NCCLS, the result was determined by strictly referring to NCCLS, and the statistical analysis was performed with the use of SPSS 13.0 software. RESULTS From Aug 2010 to Aug 2012, the infections occurred in 96 of 286 patients who underwent the artificial joint replacement surgery with the infection rate of 33.6%. Totally 112 strains of pathogens have been isolated from the 96 cases of infections, including 49 （43.75 %） strains of gram-positive bacteria and 63 （56.25% ） strains of gram-negative bacteria. The drug resistance rates of the main gram-positive bacteria to temozolomide, lincomycin, and teicoplanin were less than 10.00 % ; the drug resistance rates of the main gram-negative bacteria to imipenem and vancomycin were less than 10.0%. CONCLUSION The incidence of postoperative infections is high in the patients undergoing the artificial joint replacement surgery; most of the pathogens are multidrug-resistant; it is necessary for the hospital to take control measures; once the postoperative infections occur, the isolation and culture of pathogens should be performed, and the antibiotics should be used based on the result of drug susceptibility testing.

关 键 词：人工关节置换手术 感染 病原菌 耐药性 

分 类 号：R619.3[医药卫生—外科学]