四肢骨折术后切口感染病原菌及危险因素

目的探讨四肢骨折患者术后切口感染病原菌及危险因素分析。方法收集2011年1月-2019年6月在重庆两江新区第一人民医院接受骨折内固定术治疗的2 431例四肢骨折患者的临床资料,并根据患者术后是否发生切口感染分为感染组和非感染组,对术后切口感染患者感染病原菌进行分析,回顾性分析两组患者性别、年龄等临床资料,单因素和多因素Logistic回归分析术后切口感染的危险因素。结果 2 431例四肢骨折患者以男性(60.14%)、年龄<60岁(68.08%)、交通事故伤(47.47%)为主,骨折类型以闭合型骨折(62.94%)为主,骨折部位以胫腓骨(40.56%)最为常见;共有70例发生术后切口感染,感染率为2.88%,其中,胫腓骨和股骨部位的感染发生率较高,分别为4.36%和4.20%;感染患者共分离出73株病原菌,其中革兰阳性菌42株占比57.53%;多因素Logistic回归分析结果显示,合并高血压、合并糖尿病、开放性骨折、受伤至手术时间≥6 h、手术时间≥180 min及引流管放置时间≥6 d为引起四肢骨折患者发生术后切口感染的独立危险因素(P<0.05)。结论四肢骨折患者术后切口感染主要发生在下肢,且其发生与多因素有关,术前进行基础疾病治疗、尽早彻底清创、缩短手术及引流管放置时间等在预防术后切口感染中起到积极作用。

Pathogens isolated from limb fracture patients with postoperative incision infections and risk factors

OBJECTIVE To explore the distribution of pathogens isolated from the limb fracture patients with postoperative incision infection and analyze the risk factors.METHODS The clinical data were collected from 2431 limb fracture patients who underwent fracture internal fixation in the First People's Hospital in Liangjiang New Area of Chongqing from Jan 2011 to Jun 2019,the patients were divided into the infection group and the non-infection group according to the status of postoperative incision infection.The distribution of pathogens was observed,the clinical data of the patients such as gender and age were retrospectively analyzed,and univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the postoperative incision infection.RESULTS Among the 2431 limb fracture patients,60.14%were males,68.08%were less than 60 years old,and 47.47%were traffic accident injuries;closed fracture(62.94%)was the predominant type of fracture,and tibiofibular fracture(40.56%)was the most common fracture site.A total of 70 patients had postoperative incision infection,with the infection rate 2.88%;the incidence rate of the infection was 4.36%among the patients with tibiofibular fracture,4.20%among the patients with femur fracture.Totally 73 strains of pathogens were isolated from the patients with infections,42(57.53%)of which were gram-positive bacteria.Multivariate logistic regression analysis showed that complication with hypertension,complication with diabetes mellitus,open fracture,interval between injury and surgery no less than 6 hours,operation duration no less than 180 min and drainage tube indwelling time no less than 6 days were the independent risk factors for the postoperative incision infection in the patients with limb fracture patients(P<0.05).CONCLUSION The patients with lower limb fracture are dominant among the limb fracture patients with postoperative incision infection,which is associated with multiple factors.It is an effective way to treat underlying diseases before surgery,conduct thorough debridement as early as possible and shorten operation duration as well as drainage tube indwelling time so as to prevent the postoperative incision infections.