开放性骨折患者发生医院感染病原学特征与危险因素分析  

Etiological characteristics and risk factors of nosocomial infections in patients with open fracture

作　　者：邝继文 杨新 肖小燕 王蕊 韩健萍 梁一民[2] 

机构地区：[1]中国人民武装警察部队海南边防总队医院骨科,海南海口570208 [2]台州市第一人民医院骨科,浙江台州318020

出　　处：《中华医院感染学杂志》2017年第19期4484-4487,共4页Chinese Journal of Nosocomiology

摘　　要：目的分析开放性骨折患者发生医院感染的细菌种类、耐药性及危险因素,为今后临床制定预防措施和合理用药提供科学依据。方法选取医院2013年3月-2016年12月间收治的开放性骨折患者980例作为研究对象,对出现院内感染患者的临床资料进行回顾性分析,研究其感染部位、病原菌类型、耐药性及危险因素。结果 980例开放性骨折患者中共有51例出现院内感染,感染率5.20%,发生感染的主要部位为呼吸道感染、骨髓炎及泌尿系统感染;共分离出64株病原菌,其中革兰阴性菌39株占60.94%;革兰阳性菌22例占34.38%;真菌3例占4.69%;根据药敏试验结果,多数革兰阴性菌对青霉素、多西环素和磺胺类抗菌药物耐药率均>80%,对氨基糖苷类及碳青霉稀类敏感性较高;而多数革兰阳性菌对青霉素类、头孢类及喹诺酮类耐药率均>65%,对万古霉素敏感性较高。年龄≥60岁、损伤程度Ⅲ级、合并糖尿病等基础疾病、卧床时间≥5d均为开放性骨折的独立危险因素(P<0.05)。结论通过分析开放性骨折发生医院感染的病原学特征、耐药性及危险因素,为外科指导抗菌药物应用提供科学依据,为医院开展感染防治措施提供理论支持。OBJECTIVE To analyze the bacterial types,drug resistance and risk factors of nosocomial infections in patients with open fractures,so as to provide scientific basis for future clinical development of preventive measures and rational drug use.METHODS A total of 980 cases of patients with open fractures admitted in the hospital from Mar.2013 to Dec.2016 were selected as the research subjects.The clinical data of patients with nosocomial infections were retrospectively analyzed.The infection sites,pathogen types,drug resistance and risk factors were investigated.RESULTS A total of 51 patients with open fractures had nosocomial infections,with the infection rate of 5.20%.The main sites of the infections were respiratory tract infections,osteomyelitis and urinary tract infection.Totally 64 strains of pathogens were isolated,of which 39strains（60.94%）were gram-negative bacteria,22strains（34.38%）were gram-positive bacteria,and 3strains（4.69%）were fungi.According to the results of drug susceptibility test,most of the gram-negative bacteria were resistant to penicillin,doxycycline and sulfonamides,with the resistant rates〉80%,and were highly sensitive to aminoglycosides and carbonyltidans.Most of the gram-positive bacteria were resistant to penicillins,cephalosporins and quinolones,with the resistant rates〉65%,and were highly sensitive to vancomycin.Age≥60years old,gradeⅢinjury,underlying diseases of diabetes mellitus and bed time≥5dwere independent risk factors for open fractures（P〈0.05）.CONCLUSION Analyzing the etiological characteristics,drug resistance and risk factors of nosocomial infections in open fractures,can provide scientific basis for the application of surgical guidance of antimicrobial agents,and provide theoretical support for development of prevention and control measures of nosocomial infections.

关 键 词：开放性骨折 医院感染 病原学特征 危险因素 

分 类 号：R687.3[医药卫生—骨科学]