骨关节术后医院感染病原学及其危险因素

目的探讨骨科关节手术后医院感染的病原菌、药敏性及其危险因素。方法收集2017年2月-2020年3月在浙江萧山医院行骨科关节手术患者524例,按照是否发生医院感染分为感染组(30例)和未感染组(494例),分析医院感染患者感染病原菌分布、药敏性、炎性介质水平,对感染发生的危险因素进行单因素及多因素Logistic回归分析。结果524例患者感染30例(5.73%);30例医院感染患者分离培养病原菌52株,革兰阴性菌29株(55.77%),革兰阳性菌20株(38.46%),真菌3株(5.77%);主要革兰阳性菌对青霉素、红霉素耐药性较强,对万古霉素、替考拉宁较为敏感;主要革兰阴性菌对头孢唑林、阿奇霉素耐药性较强,对西司他丁、美罗培南较为敏感;感染患者血清超敏C-反应蛋白(hs-CRP)、降钙素原(PCT)、红细胞沉降率(ESR)、肿瘤坏死因子-ɑ(TNF-ɑ)水平高于未感染患者(P<0.05);经单因素和多因素分析发现,无指征用抗菌药物、导尿管应用、呼吸机应用是骨科关节手术后医院感染的独立危险因素(P<0.05)。结论骨科关节手术医院感染病原菌中以革兰阴性菌为主,用药前应进行药敏试验,选用合理的抗菌药物进行治疗,炎性因子水平对医院感染评估有一定价值,根据感染的相关危险因素采取措施预防感染。

Etiological characteristics and risk factors for postoperative nosocomial infection in orthopedic joint surgery patients

OBJECTIVE To explore the distribution of pathogens,drug susceptibility and risk factors for postoperative nosocomial infection in the orthopedic joint surgery patients.METHODS A total of 524 patients who underwent orthopedic joint surgery in Xiaoshan Hospital from Feb 2017 to Mar 2020 were enrolled in the study and divided into the infection group with 30 cases and the non-infection group with 494 cases.The distribution of pathogens,drug susceptibility and inflammatory mediators of the patients with nosocomial infection were observed,and univariate analysis and multivariate logistic regression analysis were performed for risk factors for the infection.RESULTS Of the 524 patients,30(5.73%)had infection.Totally 52 strains of pathogens were isolated from the 30 patients with nosocomial infection,29(55.77%)of which were gram-negative bacteria,20(38.46%)were gram-positive bacteria,and 3(5.77%)were fungi.The main gram-positive bacteria were highly resistant to penicillin and erythromycin but were susceptible to vancomycin and teicoplanin.The main gram-negative bacteria were highly resistant to cefazolin and azithromycin but were susceptible to cilastatin and meropenem.The levels of serum high-sensitivity C-reactive protein(hs-CRP),procalcitonin(PCT),erythrocyte sedimentation rate(ESR)and tumor necrosis factor-ɑ(TNF-ɑ)of the infection group were significantly higher than those of the non-infection group(P<0.05).Univariate analysis and multivariate analysis showed that use of antibiotics without indications,use of urinary catheter and use of ventilator were independent risk factors for the postoperative nosocomial infection in the orthopedic joint surgery patients(P<0.05).CONCLUSION The gram-negative bacteria are dominant among the pathogens that are isolated from the orthopedic joint surgery patients with postoperative nosocomial infection.It is necessary to reasonably use antibiotics based on the result of drug susceptibility testing,the inflammatory factors have certain value in assessment of the nosocomial infection,and the prevention measures are taken according to the related risk factors.