煤矿井下冒顶事故致创伤性胫骨骨髓炎的致病菌培养及多重耐药菌感染风险因素分析  

Disease-causing bacteria culture and risk factors analysis of multidrug resistant bacterial infections in traumatic tibial osteomyelitis caused by roof fall accidents of underground coal mine

作　　者：秦宝聚 李朝争 杨哲 宋倩 QIN Baoju;LI Chaozheng;YANG Zhe;SONG Qian(The Infection Management Department of North China Medical&Health Group Xingtai General Hospital,Xingtai Hebei 054000,China)

机构地区：[1]华北医疗健康集团邢台总医院感染管理部,河北邢台054000 [2]华北医疗健康集团邢台总医院综合部,河北邢台054000 [3]华北医疗健康集团邢台总医院药学部,河北邢台054000 [4]华北医疗健康集团邢台总医院医学检验科,河北邢台054000

出　　处：《中国急救复苏与灾害医学杂志》2025年第2期174-177,共4页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：邢台市市级科技计划项目(编号:2020ZC381)。

摘　　要：目的研究煤矿井下创伤性胫骨骨髓炎患者的骨组织和分泌物中致病菌的种类分布,以及多重耐药细菌(MDRO)感染的风险因素。方法本研究通过回顾性研究的方式,纳入2011年1月—2020年1月在华北医疗健康集团邢台总医院骨外科接受治疗的96名因煤矿井下冒顶事故所致创伤性胫骨骨髓炎男性患者的临床数据。研究对象根据手术后抗生素耐药菌株的感染情况被归为2个不同的类别:一组是由40例患者构成的感染组,另一组则是有56例未发生此类感染的非感染组。对所有患者进行骨组织和术后伤口分泌物的细菌培养和药物敏感性测试,研究致病菌的分布情况,并通过单变量和多变量Logistic回归分析来探讨MDRO感染的相关风险因素。结果在96例患者中,细菌培养共分离出152株致病菌,包括38株革兰阴性细菌(主要是大肠埃希菌和铜绿假单胞菌)和114株革兰阳性细菌(以金黄色葡萄球菌和表皮葡萄球菌为主)。单变量分析表明,医院感染、复发次数、感染性窦道形成、脓肿形成、住院次数、抗菌药物使用频次、更换抗菌药物种类数目以及联合使用抗菌药物种类数目等因素与MDRO感染风险增加相关(P<0.05)。手术清除病灶和局部冲洗引流被认为是预防MDRO感染的保护性因素(P<0.05)。多变量Logistic回归分析进一步确认,医院感染、感染性窦道形成、联合使用抗菌药物种类数目、更换抗菌药物种类数目和抗菌药物使用频次是MDRO感染的独立风险因素,而清除病灶则是MDRO感染的独立保护因素(P<0.05)。结论创伤性胫骨骨髓炎患者术后骨组织和伤口分泌物中以革兰阳性细菌为主,根据致病菌的种类合理使用抗菌药物,有效处理窦道感染、尽快清除感染病灶以及降低医院内部感染率是减少MDRO感染的关键措施;此外,矿井下工人早期的自救互助措施,如保护创面、预防性使用抗生素等对降低感染风险�Objective To explore the distribution of disease-causing bacteria in bone and secretions patients with traumatic tibial osteomyelitis caused by roof fall accidents of underground coal mines,and the actors for multidrug resistant bacteria(MDRO)infection.Methods A retrospective review was performed on the clinical data of 96 male patients with traumatic tibial osteomyelitis caused by underground coal mine disasters who were treated in the Orthopedic Surgery Department of North China Medical&Health Group Xingtai General Hospital,from January 2011 to January 2020.The study subjects were divided into two different categories based on their infection status with antibiotic-resistant strains post-surgery:an infected group of 40 patients and a group of 56 patients who did not develop such infections.Bacteria cultures and drug sensitivity testing of bone tissue and postoperative wound secretion were performed on all patients to study the distribution of disease-causing bacteria,and univariate and multivariate Logistic regression analysis were used to explore the risk factors related to MDRO infection.Results Among 96 patients,a total of 152 disease-causing bacteria were isolated by bacterial culture,including 38 strains of Gramnegative bacteria(mainly Escherichia coli and Pseudomonas aeruginosa)and 114 strains of Gram-positive bacteria(mainly Staphylococcus aureus and Staphylococcus epidermidis).Univariate analysis showed that factors such as hospital infection,number of recurrences,formation of infectious sinus tracts,abscess formation,number of hospitalizations,frequency of antimicrobial drug use,the number of types of antibiotics changed and the number of types of antibiotics used in combination were associated with an increased risk of MDRO infection(P<0.05).Surgical removal of lesions and local irrigation and drainage were considered protective factors in preventing MDRO infection(P<0.05).Multivariable Logistic regression analysis further confirmed that nosocomial infection,infectious sinus formation,the number of ty

关 键 词：煤矿井下 冒顶事故 创伤性胫骨骨髓炎 致病菌 多重耐药细菌 

分 类 号：R681.2[医药卫生—骨科学]