开放性骨折感染的病原菌分布特点及危险因素分析  

Analysis of pathogen distribution characteristics and risk factors of open fracture infection

作　　者：张凤霞 许志阳 陈巧凤[1] ZHANG Fengxia;XU Zhiyang;CHEN Qiaofeng(Fujian Medical University Affiliated Quanzhou First Hospital,Quanzhou 362000,Fujian,China)

机构地区：[1]福建医科大学附属泉州第一医院,福建泉州362000

出　　处：《中国病原生物学杂志》2025年第4期521-525,共5页Journal of Pathogen Biology

摘　　要：目的探讨开放性骨折感染患者的主要病原菌种类、分布情况及其相关危险因素,为临床预防和治疗提供理论依据。方法对比分析2021-2023年于本院接受治疗的262例开放性骨折患者的临床资料,按照是否合并感染进行分组,对比两组患者临床资料分析其影响因素。对合并感染的患者进行病原菌种类鉴定,分析其分布特点。测定患者血清CRP、ESR、D-二聚体水平,采用受试者工作特征曲线分析各项指标对开放型骨折合并感染的诊断价值。结果262例开放性骨折患者中,36例并发感染,感染率为13.74%。共检出36株病原菌,革兰阳性菌占55.56%,革兰阴性占36.11%,真菌占8.33%(3/36)。革兰阳性菌中,金黄色葡萄球菌占最高;革兰阴性菌中,铜绿假单胞菌占最高;真菌均为白色假丝酵母菌。单因素分析发现年龄、骨折分型、骨折至入院时间、糖尿病、手术时机、住院时间、手术时长、手术切口等在两组间有显著差异(P<0.05),而性别、骨折部位、受伤侧别、高血压无显著差异(P>0.05)。进一步分析表明,年龄≥65岁、骨折分型为Ⅲ型、骨折至人院时间≥6h、择期手术、住院时间14d、手术时长≥3h、手术切口为Ⅱ~Ⅲ类的开放性骨折患者感染风险更高(P<0.05)。对比两组患者血清水平,感染组患者血清CRP、ESR、D-二聚体水平显著高于未感染组患者。ROC曲线分析显示,三项指标联合诊断开放性骨折合并感染的诊断效能最高,AUC为0.984(95%CI 0.9700.998)。丝结论开放性骨折患者感染病原菌种类繁多,革兰阳性菌占最高,主要为金黄色葡萄球菌。高龄、骨折分型为Ⅲ型、延迟入院、择期手术等是感染的高危因素,这些因素可能导致患者住院时间延长,感染风险增加。感染组患者血清CRP、ESR、D-二聚体水平显著升高,三项指标的联合检测对于评估开放性骨折患者感染风险具有重要意义。Objective To explore the main pathogen species,distribution and related risk factors of patients with open fracture infection,so as to provide a theoretical basis for clinical prevention and treatment.MethodsThe clinical data of 262 patients with open fractures who were treated in our hospital from 2021 to 2023 were compared and analyzed.They were grouped according to whether there was combined infection.The clinical data of the two groups of patients were compared to analyze the influencing factors.The pathogen species of patients with combined infection were identified to analyze their distribution characteristics.The levels of serum CRP,ESR and D-dimer were measured in patients.The diagnostic value of each index were analyzed by the receiver operating characteristic curve for open fracture complicated with infection.Results Among 262 patients with open fractures,36 cases had concurrent infections,with an infection rate of 13.74%.A total of 36 pathogenic bacteria were detected.Among them,Gram-positive bacteria accounted for 55.56%,Gram-negative bacteria accounted for 36.11%,and fungi accounted for 8.33%.Among Gram-positive bacteria,Staphylococcus aureus accounted for the highest proportion;among Gram-negative bacteria,Pseudomonas aeruginosa accounted for the highest proportion;all fungi were Candida albicans.Univariate analysis showed that there were significant differences in age,fracture classification,time from fracture to admission,diabetes,timing of surgery,length of hospital stay,duration of surgery,and surgical incision between the two groups(P<0.05),while there were no significant differences in gender,fracture location,injured side,and hypertension(P>0.05).Further analysis showed that open fracture patients with age≥65 years old,fracture classification as type Ⅲ,time from fracture to admission≥6 hours,elective surgery,length of hospital stay≥14 days,duration of surgery≥3 hours,and surgical incision of type Ⅱ~Ⅲ had a higher risk of infection(P<0.05).By comparing the serum levels of the two

关 键 词：开放性骨折 感染 病原菌 影响因素 

分 类 号：R47[医药卫生—护理学]