上肢开放骨折患者术区多重耐药菌感染的影响因素分析  

Analysis of influencing factors of multidrug-resistant bacterial infection in the surgical area of patients with upper limb open fractures

作　　者：蔡磊 印飞 王秋波 葛新 芮永军 于春梅[2] Cai Lei;Yin Fei;Wang Qiubo;Ge Xin;Rui Yongjun;Yu Chunmei(Department of Hospital Infection-Control,Wuxi No.9 People's Hospital,Wuxi 214000,China;School of Public Health,Nanlong University,Nantong 226000,China)

机构地区：[1]无锡市第九人民医院院感科,无锡214000 [2]南通大学公共卫生学院,南通226000

出　　处：《中华手外科杂志》2024年第5期444-448,共5页Chinese Journal of Hand Surgery

摘　　要：目的 探讨上肢开放骨折患者术区多重耐药菌感染的影响因素.方法 回顾性分析我院自2017年1月至2023年12月就诊的上肢开放骨折患者资料,将术区多重耐药菌感染的病例作为观察组,术区一般细菌感染(非多重耐药菌感染)的患者作为对照组.以术后术区发生多重耐药菌感染与否作为因变量,以患者因素、损伤因素、手术因素等在内的15个可能导致感染的因素作为自变量,采用二分类Logistic回归模型进行单因素和多因素分析.结果 上肢开放性骨折患者术后出现术区细菌感染患者1 595例,其中多重耐药菌感染341例,占比21.4%.菌株分布:多重耐药鲍曼不动杆菌(MDR-Ab)116株、耐甲氧西林金黄色葡萄球菌(MRSA)96株、产ESBLs大肠埃希菌67株、铜绿假单胞菌33株、产ESBL肺炎克雷伯菌29株.单因素及多因素Logistic回归分析显示,年龄、基础疾病、贫血、受伤季节、骨折Gustilo分型、创面覆盖方式、住院时间、是否入住ICU、感染前30 d内抗生素使用种类及感染前30 d内抗生素使用时间是上肢开放骨折术后术区多重耐药菌感染的独立危险因素(P<0.05).结论 我院上肢开放骨折患者的多重耐药菌感染菌株分布较广.年龄、基础疾病、贫血、受伤季节、骨折分型、创面覆盖方式、住院时间、是否入住ICU、感染前30 d内抗生素使用种类及感染前30 d内抗生素使用时间是上肢开放骨折术后术区多重耐药菌感染的主要影响因素.Objective To explore the influencing factors of multidrug-resistant bacterial infection in the surgical area of patients with upper limb open fractures.Methods A retrospective analysis was conducted on the data of patients with upper limb open fractures who visited our hospital from January 2017 to December 2023.The patients with multidrug-resistant bacterial infections in the surgical area were selected as the observation group,while patients with general bacterial infections(non multidrug-resistant bacterial infections)in the surgical area were selected as the control group.The occurrence of multidrug-resistant bacterial infection in the postoperative area was used as the dependent variable and 15 potential factors that might lead to infection,including patient factors,injury factors,and surgical factors,as independent variables.A binary Logistic regression model was used for univariate and multivariate analysis.Results 1595 patients with open upper limb fractures developed postoperative bacterial infections in the surgical area,including 341 cases of multidrug-resistant bacterial infections,accounting for 21.4%.Strain distribution:116 strains of multidrug-resistant Acinetobacter baumannii(MDR-Ab),96 strains of methicillin-resistant Staphylococcus aureus(MRSA),67 strains of ESBL producing Escherichia coli,33 strains of Pseudomonas aeruginosa,and 29 strains of ESBL producing Klebsiella pneumoniae.The univariate and multivariate Logistic regression analysis showed that age,underlying disease,anemia,injury season,Gustilo fracture classification,wound coverage method,length of hospital stay,ICU admission,type of antibiotic use within 30 days before infection,and duration of antibiotic use within 30 days before infection were independent risk factors for multidrug-resistant bacterial infections in the surgical area after upper limb open fracture surgery(P<0.05).Conclusion The distribution of multidrug-resistant bacterial strains in patients with upper limb open fractures in our hospital is relatively wide.Age,underl

关 键 词：骨折 上肢 多重耐药菌 耐药性 

分 类 号：R687.3[医药卫生—骨科学]