骨盆骨折患者急诊术后切口感染的危险因素和病原学分析
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摘要
目的探讨骨盆骨折患者急诊术后切口感染的危险因素和病原学。方法回顾性收集中国人民解放军空军军医大学第一附属医院2015年10月至2018年9月收治的骨盆骨折急诊术后患者356例为研究对象,根据术后是否发生切口感染将入选患者分为感染组(28例)和未感染组(328例),观察两组患者的临床特征,并分析骨盆骨折急诊术后切口感染的危险因素和病原学特点。结果感染组患者损伤严重程度评分(injury severity score,ISS)和急性生理与慢性健康状况评分系统Ⅱ评分均显著高于未感染组(均P <0.01),Tile分型为C型、颅脑损伤、休克、膀胱尿道损伤、直肠会阴损伤及糖尿病患者占比均显著高于未感染组(均P <0.01)。多因素Logistic回归分析显示:颅脑损伤、膀胱尿道损伤、直肠会阴损伤、休克及ISS≥20分均是骨盆骨折患者急诊术后切口感染的危险因素(均P <0.05)。大肠埃希菌、金黄色葡萄球菌及铜绿假单胞菌是骨盆骨折急诊术后切口感染最常见的病原菌,分别占30.00%、26.67%及13.33%。结论颅脑损伤、膀胱尿道损伤、直肠会阴损伤、休克及ISS≥20分是骨盆骨折患者急诊术后切口感染的危险因素,感染病原菌以大肠埃希菌、金黄色葡萄球菌及铜绿假单胞菌常见,应针对上述危险因素及病原学特点制订有效的干预措施。
Objective To investigate the risk factors and etiology of incision infection after emergency surgery of pelvic fracture.Method A total of 356 patients with pelvic fracture treated in the First Affiliated Hospital of PLA Air Force Military Medical University from October 2015 to September 2018 were collected retrospectively, the selected patients were divided into infection group(n=28)and non-infection group(n=328) according to the occurrence of incision infection after surgery, the clinical characteristics of the two groups were observed, the risk factors and etiology of incision infection after emergency surgery of pelvic fracture were analyzed. Result The injury severity score(ISS) and acute physiological and chronic health evaluation Ⅱ in infection group were significantly higher than those in non-infection group(all P<0.01). The patient proportion of Tile classification of type C, craniocerebral injury, shock,bladder and urethra injury, rectum and perineum injury and diabetes melitus were significantly higher than those in non-infection group(al P<0.01). Multivariate Logistic regression analysis showed that craniocerebral injury, bladder and urethra injury, rectum and perineum injury, shock and ISS≥20 points were the risk factors of incision infection after emergency surgery of pelvic fracture(all P<0.05).Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa were the most common pathogens, accounting for 30.00%, 26.67%and 13.33%, respectively. Conclusion Brain injury, bladder and urethra injury, rectum and perineum injury, shock and ISS≥20 points are risk factors of incision infection in pelvic fracture patients after emergency surgery. The commonly pathogenic bacteria were Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, effective intervention measures should be formulated according to the above risk factors and etiological characteristics.
Objective To investigate the risk factors and etiology of incision infection after emergency surgery of pelvic fracture.Method A total of 356 patients with pelvic fracture treated in the First Affiliated Hospital of PLA Air Force Military Medical University from October 2015 to September 2018 were collected retrospectively, the selected patients were divided into infection group(n=28)and non-infection group(n=328) according to the occurrence of incision infection after surgery, the clinical characteristics of the two groups were observed, the risk factors and etiology of incision infection after emergency surgery of pelvic fracture were analyzed. Result The injury severity score(ISS) and acute physiological and chronic health evaluation Ⅱ in infection group were significantly higher than those in non-infection group(all P<0.01). The patient proportion of Tile classification of type C, craniocerebral injury, shock,bladder and urethra injury, rectum and perineum injury and diabetes melitus were significantly higher than those in non-infection group(al P<0.01). Multivariate Logistic regression analysis showed that craniocerebral injury, bladder and urethra injury, rectum and perineum injury, shock and ISS≥20 points were the risk factors of incision infection after emergency surgery of pelvic fracture(all P<0.05).Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa were the most common pathogens, accounting for 30.00%, 26.67%and 13.33%, respectively. Conclusion Brain injury, bladder and urethra injury, rectum and perineum injury, shock and ISS≥20 points are risk factors of incision infection in pelvic fracture patients after emergency surgery. The commonly pathogenic bacteria were Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, effective intervention measures should be formulated according to the above risk factors and etiological characteristics.
引文
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[15]Munyaka PM,Sepehri S,Ghia JE,et al.Carrageenan Gum and Adherent Invasive Escherichia coli in a Piglet Model of Inflammatory Bowel Disease:Impact on Intestinal Mucosaassociated Microbiota[J].Front Microbiol,2016,7(4):462-469.
[16]Bian X,Wang TT,Xu M,et al.Effect of Lactobacillus Strains on Intestinal Microflora and Mucosa Immunity in Escherichia coli O157:H7-Induced Diarrhea in Mice[J].Curr Microbiol,2016,73(1):65-70.
[17]van Staden Adu P,Heunis T,Smith C,et al.Efficacy of Lantibiotic Treatment of Staphylococcus aureus-Induced Skin Infections,Monitored by In Vivo Bioluminescent Imaging[J].Antimicrob Agents Chemother,2016,60(7):3948-3955.
[18]Park JM,Jo JH,Jin H,et al.Change in Antimicrobial Susceptibility of Skin-Colonizing Staphylococcus aureus in Korean Patients with Atopic Dermatitis during Ten-Year Period[J].Ann Dermatol,2016,28(4):470-478.
[19]Vaez H,Moghim S,Nasr Esfahani B,et al.Clonal Relatedness among Imipenem-Resistant Pseudomonas aeruginosa Isolated from ICU-Hospitalized Patients[J].Crit Care Res Pract,2015,21(4):3207-3211.
[20]Planquette B,Peron J,Dubuisson E,et al.Antibiotics against Pseudomonas aeruginosa for COPD exacerbation in ICU:a 10-year retrospective study[J].Int J Chron Obstruct Pulmon Dis,2015,10(5):379-388.
[2]Yang NP,Chan CL,Chu D,et al.Epidemiology of hospitalized traumatic pelvic fractures and their combined injuries in Taiwan:2000-2011 National Health Insurance data surveillance[J].Biomed Res Int,2014,21(5):881-889.
[3]Andrich S,Haastert B,Neuhaus E,et al.Epidemiology of Pelvic Fractures in Germany:Considerably High Incidence Rates among Older People[J].PLo S One,2015,10(9):78-87.
[4]Zhao XG.Emergency management of hemodynamically unstable pelvic fractures[J].Chin J Traumatol,2011,14(6):363-366.
[5]Han G,Wang Z,Du Q,et al.Damage-control orthopedics versus early total care in the treatment of borderline high-energy pelvic fractures[J].Orthopedics,2014,37(12):1091-1100.
[6]Wu T,Chen W,Zhang Q,et al.Therapeutic effects of minimally invasive adjustable and locking compression plate for unstable pelvic fractures via posterior approach[J].Int J Clin Exp Med,2015,8(1):827-835.
[7]Buller LT,Best MJ,Quinnan SM.A Nationwide Analysis of Pelvic Ring Fractures:Incidence and Trends in Treatment,Length of Stay,and Mortality[J].Geriatr Orthop Surg Rehabil,2016,7(1):9-17.
[8]Vaidya R,Scott AN,Tonnos F,et al.Patients with pelvic fractures from blunt trauma.What is the cause of mortality and when?[J].Am J Surg,2016,211(3):495-500.
[9]Ojodu I,Pohlemann T,Hopp S,et al.Predictors of mortality for complex fractures of the pelvic ring in the elderly:a twelveyear review from a German level I trauma center[J].Injury,2015,46(10):1996-1998.
[10]马玉鹏.骨盆骨折术后感染相关风险因素的临床分析[D].济南:山东大学,2014.
[11]Burlew CC,Moore EE,Stahel PF,et al.Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures[J].J Trauma Acute Care Surg,2017,82(2):233-242.
[12]Swaid F,Peleg K,Alfici R,et al.Does Severity of Pelvic Fractures Correlate with the Incidence of Associated IntraAbdominal Injuries in Children?[J].Eur J Pediatr Surg,2016,26(3):287-290.
[13]Matsuo K,Prather CP,Ahn EH,et al.Significance of perioperative infection in survival of patients with ovarian cancer[J].Int J Gynecol Cancer,2012,22(2):245-253.
[14]Djuikoue IC,Woerther PL,Toukam M,et al.Intestinal carriage of Extended Spectrum Beta-Lactamase producing E.coli in women with urinary tract infections,Cameroon[J].J Infect Dev Ctries,2016,10(10):1135-1139.
[15]Munyaka PM,Sepehri S,Ghia JE,et al.Carrageenan Gum and Adherent Invasive Escherichia coli in a Piglet Model of Inflammatory Bowel Disease:Impact on Intestinal Mucosaassociated Microbiota[J].Front Microbiol,2016,7(4):462-469.
[16]Bian X,Wang TT,Xu M,et al.Effect of Lactobacillus Strains on Intestinal Microflora and Mucosa Immunity in Escherichia coli O157:H7-Induced Diarrhea in Mice[J].Curr Microbiol,2016,73(1):65-70.
[17]van Staden Adu P,Heunis T,Smith C,et al.Efficacy of Lantibiotic Treatment of Staphylococcus aureus-Induced Skin Infections,Monitored by In Vivo Bioluminescent Imaging[J].Antimicrob Agents Chemother,2016,60(7):3948-3955.
[18]Park JM,Jo JH,Jin H,et al.Change in Antimicrobial Susceptibility of Skin-Colonizing Staphylococcus aureus in Korean Patients with Atopic Dermatitis during Ten-Year Period[J].Ann Dermatol,2016,28(4):470-478.
[19]Vaez H,Moghim S,Nasr Esfahani B,et al.Clonal Relatedness among Imipenem-Resistant Pseudomonas aeruginosa Isolated from ICU-Hospitalized Patients[J].Crit Care Res Pract,2015,21(4):3207-3211.
[20]Planquette B,Peron J,Dubuisson E,et al.Antibiotics against Pseudomonas aeruginosa for COPD exacerbation in ICU:a 10-year retrospective study[J].Int J Chron Obstruct Pulmon Dis,2015,10(5):379-388.