开放性骨折内固定切口病原菌感染特征及耐药性变迁  

Infection characteristics and drug resistance change of pathogenic bacteria causing incision infections after the open fracture and internal fixation

作　　者：黄伟丽[1] 毕瑶[2] 石新艳[3] 刘广义[4] 

机构地区：[1]青岛大学医学院附属医院感染管理科,山东青岛266003 [2]青岛市市立医院手术室,山东青岛266003 [3]青岛大学医学院附属医院普外科,山东青岛266003 [4]青岛大学医学院附属医院脑血管病研究所,山东青岛266003

出　　处：《中华医院感染学杂志》2014年第19期4740-4741,4770,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81141078)

摘　　要：目的探讨开放性骨折内固定术后切口病原菌感染特征及耐药性分析,为临床合理使用抗菌药物治疗病原菌感染提供依据。方法对2012年1月-2013年6月行开放性骨折内固定手术后切口感染的127例患者临床资料进行回顾性分析,采用法国生物梅里埃公司VITEK-60全自动微生物鉴定分析仪进行细菌鉴定,药敏试验采用琼脂稀释法,数据采用SPSS13.0软件进行统计分析。结果 281例开放性骨折内固定患者术后发生切口感染127例,感染率为45.2%;从脓液和分泌物中共检出病原菌356株,其中革兰阴性杆菌263株占73.9%,革兰阳性球菌93株占26.1%,前3位病原菌分别为鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌,分别占34.8%、25.0%、12.1%;鲍氏不动杆菌对氨苄西林、替卡西林/克拉维酸、头孢他啶、头孢噻肟、头孢吡肟等耐药率均>80.0%,铜绿假单胞菌对氨苄西林、头孢唑林耐药率均为100.00%,金黄色葡萄球菌对青霉素G、氨苄西林、红霉素耐药率较高,分别为97.67%、83.72%和86.05%。结论开放性骨折内固定术后患者切口感染病原菌种类复杂多样,而病原菌对多种抗菌药物的耐药率呈逐年上升趋势,应加强对病原菌药敏监测,合理使用抗菌药物,预防医院感染的暴发流行。OBJECTIVE To explore the infection characteristics and drug resistance analysis of the pathogenic bacteria causing incision infections after the open fracture and internal fixation so as to provide basis for clinical reasonable use of antibiotics in treatment of pathogens infections.METHODS The clinical data of 127 patients with incision infections who underwent open fracture and internal fixation from Jan.2012 to Jun.2013 were analyzed retrospectively.French BioMerieux company produced VITEK-60 automatic microbiological assay analyzer was used for bacteria detection.Agar dilution was used for drug sensitivity test.The data were statistically analyzed by SPSS13.0software.RESULTS A total of 127 patients out of 281 patients with postoperative open fracture and internal fixation occurred incision infections with the infection rate of 45.2%.A total of 356 pathogenic bacteria were detected from liquor puris and secretions including 263 strains of gram negative bacteria accounting for73.9%,and 93 strains of gram positive coccus accounting for 26.1%.The top three pathogens were A.baumannii accounting for 34.8%,P.aeruginosaaccounting for 25.0%and S.aureus accounting for 12.1%.Resistance of A.baumannii to ampicillin,ticarcillin/clavulanic acid,ceftazidime,cefotaxime,cefepime,were all higher than80.0%.Resistance of P.aeruginosato ampicillin and cefazolin were 100.00%.The drug resistance rates of S.aureus to benzylpenicillin G,ampicillin and erythromycin were 97.67%,83.72% and 86.05%.CONCLUSION The species of pathogens causing incision infections in the patients undergoing open fracture and internal fixation are complex and multiplex and the drug resistance rates to the various antibiotics is increasing year by year.It is necessary to intensify the detection of pathogens,monitor of drug sensitivity,and reasonably use antibiotics so as to prevent the outbreak and prevalence of nosocomial infections.

关 键 词：股骨干开放性骨折 内固定 切口感染 病原菌 耐药率 

分 类 号：R378[医药卫生—病原生物学]