创伤性胫腓骨骨折患者创口感染病原菌分布与耐药性特点及相关预防措施研究  

Distribution and drug resistance of pathogens causing wound infections in patients with traumatic tibiofibular fracture and prevention measures

作　　者：林德涛 赵宇 代风波 孔晖 吴圣润 LIN De-tao;ZHAO Yu;DAI Feng-bo;KONG Hui;WU Sheng-run(Cangnan County People＇s Hospital,Cangnan,Zhejiang 325800,Chin)

机构地区：[1]苍南县人民医院骨科,浙江苍南325800

出　　处：《中华医院感染学杂志》2018年第13期2009-2011,2019,共4页Chinese Journal of Nosocomiology

基　　金：浙江省中医药重点研究基金资助项目(2014ZA124)

摘　　要：目的研究分析创伤性胫腓骨骨折创口感染患者的病原菌分布、耐药性情况、感染相关因素及相关预防措施。方法选取2015年2月-2017年3月医院收治的创伤性胫腓骨骨折患者160例,入院后对所有患者骨折创口区的引流液或渗出液标本进行菌株分离及药敏试验检查。结果 160例患者创口感染60例,感染率为37.5%,经细菌培养后共分离病原菌133株,其中革兰阳性菌69株,占51.88%,革兰阴性菌52株,占39.10%,真菌12株,占9.02%。金黄色葡萄球菌、凝固酶阴性葡萄球菌、表皮葡萄球菌对氨苄西林/舒巴坦、红霉素、青霉素G、左氧氟沙星的耐药率均>75.0%,而对万古霉素、替考拉宁最为敏感;大肠埃希菌、铜绿假单胞菌、鲍氏不动杆菌对氨苄西林、磺胺甲噁唑/甲氧苄啶、头孢唑林、左氧氟沙星、环丙沙星的耐药率均>65.0%,而大肠埃希菌对亚胺培南、美罗培南最敏感,铜绿假单胞菌、鲍氏不动杆菌对妥布霉素、哌拉西林/他唑巴坦敏感性最高。创口感染相关因素方面,创口面积≥5cm^2、创口深度≥2.5cm、创伤至治疗时间>6小时、骨折分型中Ⅲ型骨折均是创伤性骨折创口感染的重要影响因素。结论创伤性胫腓骨骨折创口感染病原菌以革兰阳性菌为主,其中又以金黄色葡萄球菌感染率最高;大多数病原菌对万古霉素、替考拉宁、妥布霉素、亚胺培南等药物最为敏感,故在对骨折创口感染预防过程中,应选择敏感抗菌药物降低感染发生率,并对骨折及创面进行及时有效处理,有利于提高患者治疗疗效及生活质量。OBJECTIVE To investigate the distribution and drug resistance of pathogens causing wound infections in patients with traumatic tibiofibular fracture,analyze the related factors for the infection and put forward the prevention measures.METHODS A total of 160 patients with traumatic tibiofibular facture who were treated in the hospital from Feb 2015 to Mar 2017 were enrolled in the study.The drainage fluid or exudate specimens were collected from fracture wound sites of the patients,the pathogens were isolated,and the drug susceptibility testing was performed.RESULTS Of the 160 patients,60 had wound infections,with the infection rate 37.5%.Totally133 strains of pathogens were isolated,69（51.88%）of which were gram-positive bacteria,52（39.10%）were gram-negative bacteria,and 12（9.02%）were fungi.The drug resistance rates of Staphylococcus aureus,coagulase-negative Staphylococci and Staphylococcus epidermidis strains to ampicillin-sulbactam,erythromycin,penicillin G and levofloxacin were more than 75.0%,however,the strains were susceptible to vancomycin and teicoplanin;the drug resistance rates of Escherichia coli,Pseudomonas aeruginosa and Acinetobacter baumannii strains to sulfamethoxazole-trimethoprim,cefazolin,levofloxacin and ciprofloxacin were more than 65.0%,however,the E.coli strains were most susceptible to imipenem and meropenem,and the P.aeruginoa and A.baumannii strains were susceptible to tobramycin and piperacillin-tazobactam.The wound area no less than 5 cm^2,wound depth no less than 2.5 cm,interval between trauma and treatment more than 6 hours,type Ⅲ fracture were the major influencing factors for the wound infections in the patients with traumatic fracture.CONCLUSIONThe grampositive bacteria are dominant among the pathogens causing the wound infections in the patients with traumatic tibiofibular fracture,the incidence rate of the S.aureus infection is the highest.Most of the pathogens are susceptible to vancomycin,teicoplanin,tobramycin and imipenem,therefore,it is necessary to choose sen

关 键 词：创伤性胫腓骨骨折 创口感染 病原菌分布 耐药性特点 预防措施 

分 类 号：R681.2[医药卫生—骨科学]