骨科术后切口感染的危险因素及病原菌分布特点分析  

Analysis of Risk Factors and Pathogen Distribution Characteristics of Incision Infection after Orthopedic Surgery

作　　者：汪红萍[1] 纪根宝 余连香[1] WANG Hongping;JI Genbao;YU Lianxiang(Department of Hospital Infection Management,Huangshan City People′s Hospital,Huangshan 245000,China;Department of Medical,Huangshan City People′s Hospital,Huangshan 245000,China)

机构地区：[1]黄山市人民医院医院感染管理科,安徽黄山245000 [2]黄山市人民医院医务科,安徽黄山245000

出　　处：《医学综述》2021年第5期1037-1040,共4页Medical Recapitulate

摘　　要：目的分析骨科术后切口感染的危险因素及病原菌分布特点。方法选取2017年5月至2019年4月黄山市人民医院收治的行骨科手术治疗的278例患者作为研究对象,根据是否存在术后切口感染分为感染组(27例)和非感染组(251例),收集入组患者性别、年龄、体质指数、手术持续时间、切口长度、是否合并糖尿病、手术方式、切口类型、术中出血量、手术时机以及合并感染患者菌株类型,多因素Logistic回归分析术后切口感染的独立危险因素,分析术后切口感染的病原菌分布特点。结果感染组患者的年龄大于非感染组,体质指数明显高于非感染组(均P<0.05),合并糖尿病、Ⅱ类及Ⅲ类切口、急诊手术比例明显高于非感染组[40.74%(11/27)比8.37%(21/251),37.04%(10/27)比42.63%(107/251),59.26%(16/27)比15.94%(40/251),48.15%(13/27)比15.94%(40/251)](均P<0.05)。多因素Logistic回归分析结果显示,高龄、合并糖尿病、Ⅱ类及Ⅲ类切口、行急诊手术是术后切口感染的独立危险因素(均P<0.05);感染患者中共分离培养出病原菌38株,其中革兰阳性菌中检出率较高的有金黄色葡萄球菌(26.32%)、表皮葡萄球菌(21.05%)和粪肠球菌(15.79%);革兰阴性菌中检出率较高的有大肠埃希菌(7.90%)、阴沟肠杆菌(7.90%)和鲍曼不动杆菌(5.26%)。结论高龄、合并糖尿病者、Ⅱ类及Ⅲ类切口、急诊手术是术后切口感染的独立危险因素;金黄色葡萄球菌、表皮葡萄球菌和粪肠球菌在切口感染中的检出率均较高。Objective To analyze and discuss the risk factors and the distribution characteristics of pathogenic bacteria for incisional infection after orthopedic surgery.Methods A total of 278 patients receiving orthopedic surgery in Huangshan City People′s Hospital from May 2017 to Apr.2019 were included.According to the presence of postoperative wound infection,the patients were divided into an infection group(27 cases)and a non-infection group(251 cases),the gender,age,body mass index,operation duration,incision length,diabetes mellitus,operation method,incision type,intraoperative blood loss,operation timing of all the patients,and bacterial type of the patients with infection were collected.Multivariate Logistic regression analysis was used to analyze the independent risk factors of postoperative incision infection and the distribution characteristics of the pathogenic bacteria.Results The age of the patients in the infection group was older than that in the non-infection group,and the body mass index was significantly higher than that in the non-infection group(all P<0.05).The proportions of patients with diabetes mellitus,typeⅡand typeⅢincision and emergency surgery were significantly higher than those of the non-infection group[40.74%(11/27)vs 8.37%(21/251),37.04%(10/27)vs 42.63%(107/251),59.26%(16/27)vs 15.94%(40/251),48.15%(13/27)vs 15.94%(40/251)](all P<0.05).Multivariate Logistic regression analysis results showed that advanced age,combining diabetes mellitus,typeⅡandⅢincision,emergency surgery were independent risk factors of postoperative incision infection(all P<0.05).A total of 38 strains of pathogenic bacteria were isolated and cultured from the infected patients,among which Staphylococcus aureus(26.32%),Staphylococcus epidermidis(21.05%)and Enterococcus faecalis(15.79%)had higher detection rates of the Gram-positive bacteria.The higher detection rates of Gram-negative bacteria were Escherichia coli(7.89%),Enterobacter cloacae(7.89%)and Acinetobacter baumannii(5.26%).Conclusion Advanced age,patie

关 键 词：骨科手术 术后切口感染 病原菌 菌株 耐药菌 危险因素 

分 类 号：R687.3[医药卫生—骨科学] R619.3[医药卫生—外科学]