骨关节感染病原学及其临床特征的回顾性研究  

Retrospective study on pathogens and clinical characteristics of osteoarticular infection

作　　者：李湘燕[1] 施学东[1] 郑波[1] LI Xiang-yan;SHI Xue-dong;ZHENG Bo(Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院,北京100034

出　　处：《中国感染控制杂志》2018年第11期969-973,共5页Chinese Journal of Infection Control

基　　金：国家科技支撑计划基金(2012EP001002)

摘　　要：目的分析骨关节感染的主要病原体分布、药敏结果及相关临床特征,为其临床治疗提供依据。方法回顾性调查北京大学第一医院2009—2016年经病原学和病理明确诊断骨关节感染的住院患者的临床资料及病原学结果,并对调查资料进行统计、分析。结果共纳入99例细菌性骨关节感染病例,分离骨关节感染病原菌100株,革兰阳性细菌占67.00%,其中葡萄球菌占49.00%,31株革兰阴性细菌中肠杆菌科细菌占67.74%。耐甲氧西林金黄色葡萄球菌(MRSA)的分离率为16.13%,葡萄球菌属细菌对氟喹诺酮类和利福平的耐药率均低于30%。合并其他部位感染(尿路感染、肠道感染、血流感染)是骨关节革兰阴性菌感染的独立危险因素(P=0.027,OR=10.536,95%CI:1.300～85.417)。结论葡萄球菌属细菌仍然是骨关节感染的主要病原体,MRSA比例较低。有尿路和肠道感染,植入物时间较长的患者出现骨关节感染时需考虑革兰阴性菌感染的可能。Objective To analyze the distribution of main pathogens, antimicrobial susceptibility, and clinical characteristics of osteoarticular infection, and provide evidence for clinical treatment.Methods A retrospective survey was conducted on clinical data and pathogenic results of hospitalized patients with osteoarticular infection diagnosed by etiology and pathology in Peking University First Hospital from 2009 to 2016, surveyed data were analyzed statistically.Results A total of 99 cases of bacterial osteoarticular infection were enrolled, 100 strains of pathogenic bacteria were isolated, gram-positive bacteria accounted for 67.00%, 49.00% of which were Staphylococcus spp ., Enterobacteriaceae bacteria accounted for 67.74% of 31 strains of gram-negative bacteria. Isolation rate of methicillin-resistant Staphylococcus aureus （MRSA） was 16.13%, resistance rates of Staphylococcus spp . to fluoroquinolones and rifampicin were both lower than 30%. Complication with other site infection （urinary tract infection, intestinal infection, bloodstream infection） was an independent risk factor for gram-negative bacterial steoarticular infection （ P =0.027, OR =10.536, 95% CI ： 1.300-85.417）. Conclusion Staphylococcus spp . is still the main pathogen causing osteoarticular infection, proportion of MRSA is low. Patients with urinary tract infection and intestinal infection as well as long duration of implant should be considered the possibility of gram-negative bacterial infection when they develop steoarticular infection.

关 键 词：骨关节感染 葡萄球菌 植入物相关感染 耐药性 抗药性 微生物 

分 类 号：R181.32[医药卫生—流行病学]