嵌甲症术后感染病原菌分布特征调查和耐药性分析  

Distribution characteristics of pathogenic bacteria and drug resistance analysis of postoperative infection in onychia

作　　者：薛鑫鑫[1] 姜洪涛[1] 刘士波[1] 刘飞 李小东[1] XUE Xinxin;JIANG Hongtao;LIU Shibo;LIU Fei;LI Xiaodong(Department of Hand and Foot Surgery,Affiliated Hospital of Chengde Medical College,Chengde,Hebei,067000,China)

机构地区：[1]承德医学院附属医院手足外科,河北承德067000

出　　处：《中国病原生物学杂志》2024年第8期967-971,共5页Journal of Pathogen Biology

基　　金：承德市科技支撑计划项目(No.201804A027)。

摘　　要：目的 探讨嵌甲症外科术后感染病原菌分布特征调查和耐药性分析。方法 选取嵌甲症患者214例作为研究对象,依据术后是否出现感染分为感染组(n=75)和非感染组(n=139),对感染组患者开展细菌分离培养,对分离获取的病原菌实施药物敏感试验;并采用Logistic回归模型分析影响嵌甲症患者术后感染的危险因素,并根据危险因素建立综合指数模型;采用ROC曲线分析危险因素及综合指数预测嵌甲症患者术后感染的AUC值、敏感度及特异度。结果 75例嵌甲症术后感染患者经细菌培养分离出84株病原菌,其中革兰阳性菌共51株、占60.71%,革兰阴性菌共29株、占34.52%,真菌共4株、占4.76%。药敏结果显示,金黄色葡萄球菌对青霉素G(100.00%)、红霉素(100.00%)的耐药率最高,其次为克林霉素(92.86%)、氨苄西林/舒巴坦(89.29%);凝固酶阴性葡萄球菌对氨苄西林/舒巴坦(100.00%)的耐药率最高,其次为青霉素G(85.71%)、四环素(64.29%);大肠埃希菌对氨苄西林(100.00%)的耐药性最高,其次为左氧氟沙星(90.91%)、磺胺甲噁唑/甲氧苄啶(86.36%);铜绿假单胞菌对氨苄西林(100.00%)的耐药性最高,其次为磺胺甲噁唑/甲氧苄啶(85.71%)、氨苄西林/舒巴坦(85.71%)。感染组与非感染组在性别、年龄、BMI、嵌甲症、饮酒史、吸烟史、高血压等资料差异无统计学意义(P>0.05);而在糖尿病史、术后定期清洁伤口、术前预防性使用抗生素、穿鞋过紧等资料差异有统计学意义(P<0.05)。Logistic回归分析显示,糖尿病史、术后未定期清洁伤口、术前预防性使用抗生素、穿鞋过紧是影响嵌甲症患者术后感染的危险因素(P<0.05)。ROC曲线分析显示,糖尿病史、术后未定期清洁伤口、术前预防性使用抗生素、穿鞋过紧及综合指数预测嵌甲症患者术后感染的AUC分别为(0.579、0.570、0.603、0.598、0.673)。结论 嵌甲症患者术后感染以金黄色葡萄球菌、凝固酶�Objective To investigate the distribution characteristics and drug resistance analysis of the pathogenic bacteria in the postoperative infection of nail insertion. Methods A total of 214 patients with nail chiropodonia were selected as the study objects and divided into infected group(n=75) and non-infected group(n=139) according to whether infection occurred after surgery. Bacteria were isolated and cultured in infected group, and drug sensitivity tests were performed on isolated pathogens. Logistic regression model was used to analyze the risk factors of postoperative infection in patients with onychia, and a comprehensive index model was established according to the risk factors. ROC curve was used to analyze risk factors and composite index to predict AUC value, sensitivity and specificity of postoperative infection in patients with onychia. Results 84 strains of pathogenic bacteria were isolated from 75 patients with posturococcal infection, of which 51 strains were gram-positive, accounting for 60.71%,29 strains were gram-negative, accounting for 34.52%,and 4 strains were fungi, accounting for 4.76%.The results showed that the resistance rate of S. aureus to penicillin G(100.00%) and erythromycin(100.00%) was the highest, followed by clindamycin(92.86%) and ampicillin/sulbactam(89.29%). The resistance rate of coagulase negative staphylococcus to ampicillin/sulbactam(100.00%) was the highest, followed by penicillin G(85.71%) and tetracycline(64.29%). The resistance of E. coli to ampicillin(100.00%) was the highest, followed by levofloxacin(90.91%) and sulfamethoxazole/trimethoprim(86.36%). Resistance to ampicillin was the highest in P. aeruginosa(100.00%),followed by sulfamethoxazole/trimethoprim(85.71%) and ampicillin/sulbactam(85.71%).There were no significant differences in gender, age, BMI,onychia, drinking history, smoking history and hypertension between the infected and non-infected groups(P > 0.05). There were significant differences in diabetes history, regular postoperative wound cleaning, prophyla

关 键 词：嵌甲症 术后感染 病原菌 分布特征 耐药性 

分 类 号：R446.5[医药卫生—诊断学] R758.72[医药卫生—临床医学]