难愈性创面感染的病原菌分布及定植感染相关因素

目的分析难愈性创面感染病原菌的分布及定植感染的相关因素，探讨相应的防治措施。 方法收集2012年至2015年本院烧伤外科难愈性创面感染者的临床资料，回顾性分析病原菌分布及定植感染相关的危险因素。 结果从难愈性创面感染中共分离出265株病原菌，其中革兰阳性菌116株（43.77%），革兰阴性菌149株（56.23%）。常见的病原菌为金黄色葡萄球菌（104株，39.25%）、铜绿假单胞菌（71株，26.79%）和大肠埃希菌（28株，10.57%）。177例患者中138例有定植感染，39例无定植感染。单因素分析结果显示，创面面积（Z =－3.970、P < 0.001）、近日住院史（χ² = 5.865、P = 0.015）、住院时间超2周（χ² = 5.869、P = 0.0154）、低血红蛋白（χ² = 6.545、P = 0.011）、近期导管植入（χ² = 5.710、P = 0.017）、近期手术（χ² = 4.320、P = 0.038）和近期输液治疗（χ² = 10.023、P = 0.002）为病原菌定植感染的危险因素。多元回归分析结果显示，创面面积（OR = 1.516、95%CI：1.140~2.015，Waldχ² = 8.179、P = 0.004）为病原菌定植感染的独立危险因素。 结论本院烧伤外科难愈性创面感染分泌物病原菌中革兰阴性菌占优势，创面面积与病原菌定植感染密切相关。

Distribution of pathogenic bacteria and risk factors of colonization and infection of refractory wound

ObjectiveTo investigate the distribution of pathogenic bacteria and the risk factors of colonization and infection on refractory wound, and to provide reference for the prevent and treatment of refractory wound infection. MethodsThe clinical data of pathogenic bacteria distribution and the risk factors of pathogenic bacteria colonization and infection on refractory wound of burns of surgery inpatients in our hospital from 2012 to 2015 were analyzed, retrospectively. ResultsTotal of 265 strains of pathogens were isolated, including 116 strains (43.77%) of Gram-positive and 149 strains (56.23%) of Gram-negatives bacteria. The common pathogenic bacteria were Staphylococcus aureus (104 strains, 39.25%), Pseudomonas aeruginosa (71 strains, 26.79%) and Escherichia coli (28 strains, 10.57%). Totally 177 patients were collected, among whom, 138 patients were with bacteria colonization and infection and 39 patients were without bacteria colonization and infection. Univariate analysis showed that wound area (Z =-3.970, P < 0.001), history of hospitalization (χ² = 5.865, P = 0.015), hospitalization period longer than two weeks (χ² = 5.869, P = 0.0154), lower hemoglobin (χ² = 6.545, P = 0.011), recent implanted catheter (χ² = 5.710, P = 0.017), recent surgery (χ² = 4.320, P = 0.038) and recent infusion (χ² = 10.023, P = 0.002) were all risk factors of positive microorganism culture results. Multivariate Logistic regression analysis indicated that wound area (OR = 1.516, 95%CI: 1.140-2.015, Waldχ² = 8.179, P = 0.004) was an independent risk factor of bacteria colonization and infection. ConclusionsGram-negatives bacteria were dominant bacteria on the refractory wound of burns surgery department of our hospital. Wound area was closely related with the pathogenic bacteria colonization and infection.