摘要
目的探讨全髋关节置换术(THA)后医院感染病原菌特征及危险因素,为临床预防和治疗提供依据。方法选择2012年3月-2017年3月639例THA患者,根据医院感染诊断标准以及病原菌检测,观察患者感染率,并分析病原菌特征及危险因素。结果 639例THA患者共发生医院感染42例,感染率6.57%,感染46例次,例次感染率为7.20%,感染部位以手术切口感染为主,占41.30%;42例感染患者共分离病原菌57株,其中革兰阴性菌19株,占33.33%,革兰阳性菌38株,占66.67%;革兰阴性菌中大肠埃希菌对亚胺培南和阿米卡星敏感率最高为100.00%,对头孢唑林敏感率最低为0,阴沟肠杆菌对亚胺培南敏感率最高为100.00%,对头孢唑林和氨苄西林敏感率最低为0;革兰阳性菌中金黄色葡萄球菌对氨苄西林敏感率最高为100.00%,对青霉素敏感率最低为0,表皮葡萄球菌对氨苄西林敏感率最高100.00%,对青霉素敏感率最低为0;年龄、BMI、合并基础疾病、合并糖尿病、既往手术史、手术时间、引流管放置时间及抗菌药物使用种类是THA术后感染的相关因素(P<0.05);合并基础疾病≥2种、合并糖尿病、抗菌药物使用种类>3种、既往有手术史是THA术后感染的独立危险因素(P<0.05)。结论 THA术后并发医院感染的高危因素较多,应针对性加强围手术期护理,降低感染率。
OBJECTIVE To explore the characteristics of pathogens causing nosocomial infections after total hip arthroplasty（THA）and analyze the risk factors so as to provide guidance for clinical prevention and treatment.METHODS A total of THA patients who were treated from Mar 2012 to Mar 2017 were enrolled in the study.According to the criteria for diagnosis of nosocomial infections and detection of pathogens,the infection rates of the patients were observed,and the characteristics of pathogens and risk factors were analyzed.RESULTS Of the 639 THA patients,totally 42 had nosocomial infections,with the infection rate 6.57%,and totally 46 case-times of patients had the infections,with the case-time infection rate 7.20%.The patients with surgical incision infections were dominant among the patients with the nosocomial infections,accounting for 41.30%.A total of 57 strains of pathogens were isolated from the 42 patients with the infections,including 19（33.33%）strains of gram-negative bacteria and 38（66.67%）strains of gram-positive bacteria.Among the gram-negative bacteria,the drug susceptibility rates of Escherichia coli strains to imipenem and amikacin were 100.00%,the drug susceptibility rate to cefazolin was 0%;the drug susceptibility rate of Enterobacter cloacae strains to imipenem was 100.00%,and the drug susceptibility rates to cefazolin and ampicillin were 0%.Among the gram-positive bacteria,the drug susceptibility rate of Staphylococcus aureus strains to ampicillin was 100.00%,and the drug susceptibility rate to penicillin was 0%,and the drug susceptibility rate to penicillin was 0%;the drug susceptibility rate of Staphylococcus epidermidis strains to ampicillin was 100.00%,and the drug susceptibility rate to penicillin was 0%.The related factors for the postoperative infections in the THA patients included the age,BMI,complication with underlying diseases,complication with diabetes mellitus,surgery history,operation duration,catheter indwelling time and types of used antibiotics（P〈0.05）.The complication with no less than 2 types of underlying diseases,complication with diabetes mellitus,use of more then 3 types of antibiotics and history of surgery were the independent risk factors for the postoperative infections in the THA patients（P〈0.05）.CONCLUSIONThere are a variety of high risk factors for the postoperative infections in the THA patients,and it is necessary to strengthen perioperative nursing so as to reduce the infection rate.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第21期4960-4963,共4页
Chinese Journal of Nosocomiology
基金
浙江省台州市科技计划基金资助项目(1702KY21)
关键词
全髋关节置换术
医院感染
病原菌
耐药性
危险因素
Total hip arthroplasty
Nosocomial infection
Pathogen
Drug resistance
Risk factor
