老年骨科植入术后切口感染的病原菌分布及危险因素分析
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摘要
目的了解老年患者骨科植入术后切口感染的病原菌分布及危险因素。方法通过病原菌分离鉴定技术和回顾性分析,对某医院行骨科植入术的老年患者术后切口感染的病原菌分布及感染发生的危险因素进行分析。结果在1 498名老年骨科手术患者中,发生手术切口感染67例,切口感染的发生率为4. 47%。从67例手术患者切口感染标本中,共分离培养出病原菌81株,其中革兰阴性菌、革兰阳性菌和真菌构成比分别为61. 73%、35. 80%和2. 47%。Logistic回归分析结果发现,年龄超过70岁、急诊手术、合并糖尿病、气压止血时间> 90 min、合并低蛋白血症、无指征使用抗菌药物和术中使用大功率电刀等是导致老年骨科手术患者术后切口感染的独立危险因素(P<0. 05)。结论老年骨科植入术患者术后切口感染的病原菌以革兰阴性菌为主,影响老年骨科植入术患者术后切口感染发生的危险因素较多,需要针对性采取干预措施。
Objective To investigate the pathogen distribution and risk factors of incisional infection in elderly patients undergoirg orthopdic implantation. Methods Pathogen isolation and identification technology and retrospective analysis were used to analyze the distribution of Pathogen and risk factors of postoperative wound infection in elderly patients undergoing orthopedic implantation in a hospital. Results Among the 1 498 elderly patients in department of orthopedics,67 patients had incision infection,and the incidence rate of incision infection was 4. 47%. Among the 67 patients,there were 81 strains of pathogenic bacteria isolated,29 strains were Gram-positive bacteria( 35. 80%),50 strains were Gram-negative bacteria( 61. 73%),and 2 strains were fungi( 2. 47%). The results of logistic regression analysis showed age > 70 years,emergency operation,combined diabetes,pressure hemostasis time > 90 min,combined hypoproteinemia,no indication of antibiotics,and high power electric knife in operation were the risk factors of post operative infection of incision for the elderly patients in department of orthopedics( P < 0. 05). Conclusion The pathogen of post operative incision infection for the elderly patients in department of orthopedics are mainly Gram-negative bacteria. There are many risk factors affecting the incidence of incision infection after orthopaedic implantation in elderly patients,and intervention measures should be taken accordingly.
Objective To investigate the pathogen distribution and risk factors of incisional infection in elderly patients undergoirg orthopdic implantation. Methods Pathogen isolation and identification technology and retrospective analysis were used to analyze the distribution of Pathogen and risk factors of postoperative wound infection in elderly patients undergoing orthopedic implantation in a hospital. Results Among the 1 498 elderly patients in department of orthopedics,67 patients had incision infection,and the incidence rate of incision infection was 4. 47%. Among the 67 patients,there were 81 strains of pathogenic bacteria isolated,29 strains were Gram-positive bacteria( 35. 80%),50 strains were Gram-negative bacteria( 61. 73%),and 2 strains were fungi( 2. 47%). The results of logistic regression analysis showed age > 70 years,emergency operation,combined diabetes,pressure hemostasis time > 90 min,combined hypoproteinemia,no indication of antibiotics,and high power electric knife in operation were the risk factors of post operative infection of incision for the elderly patients in department of orthopedics( P < 0. 05). Conclusion The pathogen of post operative incision infection for the elderly patients in department of orthopedics are mainly Gram-negative bacteria. There are many risk factors affecting the incidence of incision infection after orthopaedic implantation in elderly patients,and intervention measures should be taken accordingly.
引文
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[3]龙彩雪,林明侠,黄世敏,等.骨折术后切口感染相关因素分析[J].中国消毒学杂志,2017,34(8):764-766.
[4]Ma WJ,Zhou Y,Mao H,et al.Healing time of incision infection after hepatobiliary surgery treated by needle-free incision suture closure[J].World J Gastroenterol,2014,20(42):15815-15819.
[5]中华人民共和国卫生部.医院感染诊断标准(试行)[S].2001.
[6]中华人民共和国卫生部医政司.全国临床检验操作规程[M].第4版.北京:人民卫生出版社,2015.
[7]Hanzlik SR,Pearson SE,Caldivell PE,3rd.Excision and reimplantation of the proximal humerus after fracture-dislocation[J].Orthopedics,2016,39(4):e779-e782.
[8]Xu X,Yang X,Li S,et al.Risk factors of lower respiratory tract infection in patients after tracheal intubation under general anesthesia in the Chinese health care system:a meta-analysis[J].Am J Infect Control,2016,44(11):e215-e220.
[9]李国威,黄汉,陈涛,等.骨科手术切口感染的相关因素分析[J].中华医院感染学杂志,2018,28(1):96-98.