胫腓骨开放性骨折患者创口感染的病原学与耐药性分析  

Etiological analysis of wound infections in patients with open fracture of tibia and fibula and analysis of drug resistance

作　　者：崔金雷[1] 宋文超[1] 李玉华[1] 

机构地区：[1]郑州人民医院骨一科,河南郑州450003

出　　处：《中华医院感染学杂志》2015年第16期3683-3685,共3页Chinese Journal of Nosocomiology

基　　金：河南省自然科学基金资助项目(0511046572)

摘　　要：目的探讨高龄胫腓骨开放性骨折患者创口感染的病原学及耐药分析,为临床治疗提供帮助。方法对2011年1月-2013年10月骨科收治的157例高龄胫腓骨开放性骨折患者进行回顾性分析,通过患者的临床资料、细菌培养等分析其感染的病原学及耐药性,数据采用SPSS 22.0软件进行统计分析。结果创口感染患者23例,感染率为14.65%;胫腓骨开放性骨折处理时间拖延越久,其感染率越高,骨折类型以GustiloⅢ型感染率最高,为48.84%;病原菌分离共174株,以革兰阳性菌为主,共92株占52.87%,万古霉素、亚胺培南、哌拉西林/他唑巴坦对其具有良好的抗菌疗效。结论高龄胫腓骨开放性骨折患者创口感染与时间及骨折分型有关,感染主要是以革兰阳性菌为主,通过加强无菌操作、严密监控耐药菌、合理使用抗菌药,可以降低感染率,提高临床疗效。OBJECTIVE To explore the etiology of wound infections in elderly patients with open fracture of tibia and fibula and analyze the drug resistance so as to provide guidance for clinical treatment .METHODS A total of 157 elderly patients with open fracture of tibia and fibula who were treated in the department of orthopedics from Jan 2011 to Oct 2013 were retrospectively analyzed .The clinical data of the patients and results of bacterial culture were investigated to analyze the etiology of the wound infections and the drug resistance ,and the statistical analy‐sis of the data was performed with the use of SPSS 22 .0 software .RESULTS The wound infections occurred in 23 cases ,with the infection rate of 14 .65% .The longer the time of treatment of open fracture of tibia and fibula de‐layed ,the higher the infection rate was .The infection rate was the highest （48 .84% ） in the patients with the type GustiloⅢ fracture .Totally 174 strains of pathogens have been isolated ,of which 52 .87% （92 strains ） were the gram‐positive bacteria ,and the strains had good antibacterial activity against vancomycin ,imipenem ,and pip‐eracillin‐tazobactam .CONCLUSION The incidence of wound infections in the elderly patients with open fracture of tibia and fibula is associated with the time and types of fracture .The gram‐positive bacteria are dominant among the pathogens causing the infections .It is an effective way to strengthen the aseptic operation ,closely monitor the drug‐resistant bacteria ,and reasonably use antibiotics so as to reduce the infection rate and improve the clinical ef‐f icacy .

关 键 词：胫腓骨骨折 病原学 耐药性 感染分析 

分 类 号：R378[医药卫生—病原生物学]