骨科开放伤口多重耐药菌感染危险因素的Logistic回归分析  

Risk factors for multi-drug resistant bacteria infection in orthopaedic open wound : a logistic regression analysis

作　　者：谢朝云[1] 闫飞[1] 熊永发[1] 熊芸[2] 李耀福[2] 

机构地区：[1]贵州医科大学第三附属医院骨科,都匀市沙包堡七星路7号558000 [2]贵州医科大学第三附属医院感染管理科,都匀市沙包堡七星路7号558000

出　　处：《中国矫形外科杂志》2017年第2期108-113,共6页Orthopedic Journal of China

基　　金：贵州省黔南州社会发展科技项目(黔南科合社字[2013]20号)

摘　　要：[目的]分析骨科开放伤口多重耐药菌感染的危险因素并提出临床防控措施。[方法]回顾2011年6月~2014年12月209例骨科开放伤口感染患者的临床资料,收集并逐一记录每位患者的性别、年龄、住院天数、伤口类型、有无基础疾病、有无合并症、有无预防使用抗菌药物、有无伤口引流、是否入住ICU、受伤至清创时间、血糖、血浆白蛋白与血红蛋白浓度、抗菌药物和糖皮质激素使用情况、细菌培养是否检出多重耐药菌,对其多重耐药菌感染的危险因素进行分析。[结果]单因素分析显示患者住院天数、使用糖皮质激素伴有基础疾病与合并症、伤口类型、抗菌药物使用时间及种数和是否联用、伤口引流、受伤-清创时间、血红蛋白浓度、血浆白蛋白浓度、血糖、是否入住ICU等均是骨科开放性伤口多重耐药菌感染的危险因素(P<0.05);多因素分析显示抗菌药物使用时间是骨科开放性伤口感染多重耐药菌的最主要因素(P<0.05)。[结论]骨科开放性伤口多重耐药菌感染与患者住院天数、使用糖皮质激素伴有基础疾病与合并症、伤口类型、抗菌药物使用时间和种数及是否联用、伤口引流、受伤-清创时间、血红蛋白浓度、血浆白蛋白浓度、血糖、是否入住ICU等多种因素有关,其中以抗菌药物使用时间为最主要因素,应针对其相关危险因素采取防控措施,以减少骨科开放性伤口多重耐药菌感染。[Objective] To analyze the risk factors of multi-drug resistant bacteria infection in orthopaedic open wound and propose clinical prevention and control measures. [Methods] Clinical data of open wound infection of 209 cases, who were admitted to the department of orthopedics from June 2011 to December 2014, were summarized retrospectively. Parameters were collected and recorded, including each patient＇s gender, age, hospital stay, wound type, basic diseases, complications, used antibiotics, wound drainage, ICU stay, time from injury to debridement, bloodglucose, plasma albumin and hemoglobin concentration, antibiotics and glucocorticoid use, respectvely. Bacteria were cultured to confirm it was multi-drug resistant bacteria, and the risk factors of muhi-drug resistant bacteria infection were analyzed. [Results] Single factor analysis showed that the hospitalized days, the use of cortieosteroids with underlying diseases and complications, wound type, the use of antibacterial drugs species, the drainage of the wound, time from wound to debridement, hemoglobin, the concentration of blood glucose and plasma albumin, ICU stay were risk factors for multi-drug resistant bacteria infection in hospitalized patients （P〈0.05） . Multi factor analysis showed that the time for use of antibacterial drugs was the main factor of open wound infection of muhi drug resistant bacteria （P〈0.05） . The number of days, the use of corticosteroids with underlying diseases and complications, wound type, the use of antibacterial drugs species, the drainage of the wound, the time from wound to debridemenl, hemoglobin, plasma albumin concentration, blood sugar, ICU or not were the risk factors for open wound of muhi-drug resistant bacteria infection. [Conclusion] Time to use of antibacterial drugs is the main factor for muhi-drug resistant bacteria infeetion in open wound. Multi-drug resistant bacteria should be noted and taken countermeasures to reduce open wound infection in department of orthopedics.

关 键 词：骨科 开放伤口 多重耐药菌 危险因素 LOGISTIC回归分析 

分 类 号：R687[医药卫生—骨科学]