骨科创伤患者院内创面多重耐药菌感染的危险因素分析  

Analysis on risk factors of nosocomial multi-drug resistant bacteria infection of wounds in orthopedic trauma patients

作　　者：张泽琼[1] 谭淦珊 王述军 宁倩[1] 何凌霄[1] 廖灯彬[1] 蒋艳[2] Zhang Zeqiong;Tan Ganshan;Wang Shujun;Ning Qian;He Lingxiao;Liao Dengbin;Jiang Yan(Trauma Center,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Nursing,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院创伤医学中心,成都610041 [2]四川大学华西医院护理部,成都610041

出　　处：《中华创伤杂志》2021年第8期726-732,共7页Chinese Journal of Trauma

摘　　要：目的:探讨骨科创伤患者院内创面多重耐药菌(MDRO)感染的相关危险因素。方法:采用回顾性病例对照研究分析2020年1月至2020年12月四川大学华西医院收治的95例骨科院内创面感染患者临床资料,其中男71例,女24例;年龄14~70岁[(42.6 ± 13.8)岁]。发生MDRO感染38例(MDRO组),未发生MDRO感染57例(非MDRO组)。观察创面感染的病原学特征。采用单因素分析比较两组患者基线资料(性别、年龄、住院时间、慢性合并症)、受伤诊治情况(是否外院转入、是否急诊入院、受伤至首次处理时间、是否开放性损伤、是否合并骨折、创面是否污染、创面深度、是否入住ICU、手术次数、累计手术时间、切口类型、确诊感染前住院时间、使用抗生素种类、是否使用激素/免疫抑制剂、入院时血红蛋白、入院时血清白蛋白、入院时血糖)。采用二分类Logistic回归分析MDRO感染发生的独立危险因素。结果:创面共检出119株致病菌,其中革兰阳性球菌21株(18%),革兰阴性杆菌91株(76%),其他7株(6%);菌株类型前五位依次为鲍曼不动杆菌、阴沟肠杆菌、大肠埃希菌、金黄色葡萄球菌和铜绿假单胞菌。单因素分析显示,两组间住院时间、创面是否污染、是否入住ICU、确认感染前住院时间、使用抗生素种类、入院时血红蛋白、入院时血清白蛋白差异有统计学意义( P < 0.05);性别、年龄、高血压、糖尿病、是否外院转入、是否急诊入院等因素,差异无统计学意义( P > 0.05)。多因素Logistic回归分析显示,住院时间长( OR = 1.033, 95%CI 1.005~1.061, P < 0.05)、受伤至首次处理时间 > 6 h( OR = 4.282, 95%CI 1.174~15.616, P < 0.05)、使用抗生素种类 ≥ 3种( OR = 7.486, 95%CI 2.451~22. 863, P < 0.05)、入院时低血红蛋白值( OR =0.973, 95%CI 0.962~0.985, P < 0.05)与MDRO感染显著相关。 结论:住院时间、受伤至首次处理时间、使用抗生素种类、入院时血红蛋白值�Objective:To investigate the risk factors of multi-drug resistant organism(MDRO)infection in orthopedic trauma patients.Methods:A retrospective case series study was made on clinical data of 95 orthopedic patients with in-hospital wound infection admitted to West China Hospital of Sichuan University from January 2020 to December 2020,including 71 males and 24 females at age of 14-70 years[(42.6 ± 13.8)years]. MDRO infection occurred in 38 patients(DRO group),while not in 57 patients(non-MDRO group). Etiological characteristics of wound infections were observed. Univariate analysis was used to compare variables between the two groups,including baseline data(gender,age,length of hospital stay,chronic comorbidity)and injury as well as hospitalization information(transfer from another hospital,emergency admission,time from injury to first treatment,open injury,combination with fracture,wound contamination,depth of wound,ICU stay,number of operations,cumulative operation time,type of incision,length of hospital stay before diagnosis of infection,type of antibiotics used,usage of hormones/immunosuppressive agents,level of hemoglobin/serum albumin/blood glucose on admission). Binary Logistic regression was used to analyze independent risk factors for MDRO infection.Results:A total of 119 pathogenic bacteria were detected on the wound,including 21 gram-positive cocci(18%),91 gram-negative bacilli(76%)and 7 others(6%). Top five strains were Acinetobacter baumannii,Enterobacter cloacae,Escherichia coli,Staphylococcus aureus and Pseudomonas aeruginosa. Univariate analysis showed the two groups had significant differences in terms of length of hospital stay,wound contamination,ICU stay,length of hospital stay before diagnosis of infection,type of antibiotics used and levels of hemoglobin and serum albumin on admission( P < 0.05),but not in gender,age,hypertension,diabetes,transfer from another hospital and emergency admission( P > 0.05). Multivariate Logistic regression analysis showed MDRD infection was obviously correlate

关 键 词：创伤和损伤 伤口感染 交叉感染 抗药性 细菌 危险因素 

分 类 号：R446.5[医药卫生—诊断学] R641[医药卫生—临床医学]