骨科患者术后感染病原菌分布特征、危险因素及相关因子水平分析  

Analysis of the distribution characteristics of pathogens causing an infection after orthopedic surgery, risk factors for infection, and levels of related factors

作　　者：杨晋[1] 瓦庆德[1] 吴兴凯[1] 范青洪[1] YANG Jin;WA Qing-de;WU Xing-kai;FAN Qing-hong(Orthopedics,Zunyi Medical College Hospital,Zunyi,Guizhou,China 563003)

机构地区：[1]遵义医学院附属医院骨一科

出　　处：《中国病原生物学杂志》2019年第9期1081-1083,1087,共4页Journal of Pathogen Biology

基　　金：贵州省科技合作计划项目(黔科合LH[2015]7496)

摘　　要：目的分析骨科患者术后感染病原菌分布情况及感染危险因素,并检测血清相关因子水平,探讨其临床意义。方法收集2016年6月至2018年6月本院收治的骨科术后感染患者90例为感染组,同期收治的骨科术后未感染患者90例为未感染组;同期健康志愿者90例为对照组。利用全自动微生物分析仪对感染组患者送检标本进行细菌的分离鉴定;对骨科术后感染危险因素进行单因素回归分析;采用ELISA和免疫荧光法检测3组受检者血清基质金属蛋白酶-9(MMP-9)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平并进行比较分析。结果90例骨科术后感染患者共检出病原菌108株,其中革兰阴性菌61株(占56.48%),以鲍曼不动杆菌及肺炎克雷伯菌为主;革兰阳性菌45株(占41.67%),以金黄色葡萄球菌及表皮葡萄球菌为主;真菌2株(占1.85%)。单因素回归法分析年龄、患糖尿病、导尿、住院及手术时间长均是骨科患者术后切口感染的危险因素(P<0.05)。ELISA和免疫荧光法检测血清MMP-9、TNF-α及CRP水平,感染组分别为(133.82±13.19)ng/mL、(92.82±0.94)pg/mL、(35.07±3.61)mg/L,非感染组为(40.49±4.06)ng/mL、(36.69±0.37)pg/mL、(18.39±1.92)mg/L,,与对照组(7.16±0.72)ng/mL、(12.56±0.14)pg/mL、(4.50±0.53)mg/L比较差异均有统计学意义(均P<0.05);感染组与非感染组患者比较差异均有统计学意义(P<0.05)。结论骨科患者术后感染病原菌以革兰阴性菌为主;年龄大、有糖尿病、住院时间及手术时间长、导尿等均会增加骨科患者术后感染的风险;术后感染者血清内炎症因子MMP-9、TNF-α及CRP水平升高,可作为诊断的依据。Objectives To analyze the distribution of pathogens causing an infection after orthopedic surgery and risk factors for infection and to measure levels of related factors in serum in order to explore their clinical significance.Methods Ninety patients who developed an infection after orthopedic surgery at this Hospital from June 2016 to June 2018 served as patients with an infection.Ninety patients who underwent orthopedic surgery during the same period but who did not develop an infection served as patients without an infection.Ninety healthy volunteers during the same period served as the control group.Pathogens were isolated and identified by an automated microbial analyzer.The risk factors for a postoperative infection were analyzed using univariate regression analysis.Serum matrix metalloproteinase-9(MMP-9)was detected using ELISA and immunofluorescence.Tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)levels were compared and analyzed.Results A total of 108 strains of pathogens were detected in 90 patients who underwent orthopedic surgery.Sixty-one of those strains were strains of Gram-negative bacteria(56.48%),which were mainly Acinetobacter baumannii and Klebsiella pneumoniae.Forty-five of the strains were strains of Gram-positive bacteria(41.67%),which were mainly Staphylococcus aureus and Staphylococcus epidermidis.Two of the strains were strains of fungi(1.85%).Univariate regression analysis indicated that age,diabetes,catheterization,a long duration of hospitalization,and a long operating time were risk factors for development of a surgical site infection after orthopedic surgery(P<0.05).Levels of serum MMP-9,TNF-α,and CRP were detected using ELISA and immunofluorescence.MMP-9 was 133.82±13.19 ng/mL,TNF-αwas 92.82±0.94 pg/mL,and CRP was 35.07±3.61 mg/L in patients with an infection.MMP-9 was 40.49±4.06 ng/mL,TNF-αwas 36.69±0.37 pg/mL,and CRP was 18.39±1.92 mg/L in patients without an infection.MMP-9 was 7.16±0.72 ng/mL,TNF-αwas 12.56±0.14 pg/mL,and CRP was 4.50±0.53 mg/L in the co

关 键 词：骨科术后感染 病原菌 危险因素 炎症因子 

分 类 号：R378[医药卫生—病原生物学]