四肢开放骨折患者伤口多药耐药菌感染的影响因素分析  

Analysis on influence factors for multi-drug resistant bacterial infections in wounds in patients with open limb fracture

作　　者：陈晓英[1] 杨爽[1] 赵静[1] 

机构地区：[1]天津医院创伤科四病区,天津300211

出　　处：《中华医院感染学杂志》2014年第12期3018-3020,共3页Chinese Journal of Nosocomiology

基　　金：天津市卫生局重点基金资助项目(TW-2010B-037)

摘　　要：目的探讨四肢开放骨折患者伤口并发多药耐药菌感染的影响因素,并提出相应的护理对策,以降低多药耐药菌感染率。方法选取四肢开放骨折术后切口感染患者5 732例,按照是否为多药耐药菌感染将其分为两组,对患者的临床资料进行回顾性分析;采用SPSS13.0软件进行分析。结果多药耐药菌感染患者年龄≥60岁、未严格无菌操作、预防性应用抗菌药物、连续卧床时间较长以及与多药耐药菌感染者共住同病房者明显多于未发生多药耐药菌感染的患者,两组比较差异有统计学意义(P<0.05);经logistic回归分析,年龄≥60岁(OR=2.196)、未严格无菌操作(OR=1.644)、预防应用抗菌药物(OR=2.583)、连续卧床≥7d(OR=2.368)、与多药耐药菌感染患者同病房(OR=7.574)等因素是四肢开放骨折患者伤口并发多药耐药菌感染的独立危险因素。结论四肢开放骨折患者伤口并多药耐药菌感染与多因素有关,在护理过程中通过隔离带菌者、严格无菌原则切断感染源,并指导患者合理饮食和运动增强机体抵抗力保护易感人群,减少多药耐药菌感染的发生。OBJECTIVE To investigate the factors affecting patients with open fracture complicated by multi-drug resistant bacterial infections （MDRBIs） in wounds ,and to put forward the corresponding nursing strategies to reduce the prevalence of MDRBIs .METHODS A total of 5732 patients with open limb fracture with postoperative wound infection were selected ,and divided into two groups according to whether it was multi-drug resistant bacterial infection . The clinical data were retrospectively reviewed and analyzed statistically with SPSS 13 .0 software .RESULTS Compared to patients without MDRBIs ,the occurrence of MDRBIs was significantly higher in patients who were ≥ 60 years ,received non-strict sterile operation ,prophylactic antibiotics ,long consecutive bed-rest or lived with patients with MDRBIs .The difference was significant with significance （P〈 0 .05） .logistic regression analysis showed factors including age ≥ 60 years （OR= 2 .196） ,non-strict sterile operation （OR=1 .644） ,prophylactic use of antibiotics （OR=2 .583） ,continuous bed-rest ≥ 7 d （OR=2 .368） ,and roommate with patients with MDRBIs （OR=7 .574） ,were the independent risk factors for wound MDRBIs in patients with open fracture .CONCLUSION Multiple factors are related to open limb fracture complicated by MDRBIs .It is suggested to cut off infection source by isolating carriers ,strict implement sterile operation ,and guide the patient to develop proper diet and exercise to enhance body immunity so as to protect susceptible population and reduce the incidence of MDRBIs .

关 键 词：开放骨折 伤口感染 多药耐药菌 因素 

分 类 号：R683[医药卫生—骨科学]