摘要
目的探讨骨科患者术后切口感染病原菌药敏及炎症因子。方法选择2020年1月-2022年1月宁波市中医院收治的骨科术后切口感染的76例(感染组)患者和切口未感染的患者52例(未感染组)为研究对象,分析术后感染情况,并对感染患者进行病原菌及药敏分析;于术后第1天、术后第3天和术后第5天检测血清C-反应蛋白(CRP)、降钙素原(PCT)、白细胞介素-6(IL-6)的表达;归纳骨科患者术后切口感染病原菌属的影响因素。结果76例骨科术后切口感染患者共培养分离病原菌88株,其中革兰阴性菌58株占65.91%和革兰阳性菌30株占34.09%;Ⅰ类切口10例,Ⅱ类切口27例,Ⅲ类切口39例;未检出对替加环素,利奈唑胺,奎奴普丁/达福普汀和莫西沙星的耐药株;金黄色葡萄球菌对利福平、头孢唑林和左氧氟沙星较敏感;表皮葡萄球菌对万古霉素和庆大霉素较敏感;铜绿假单胞菌和大肠埃希菌对头孢曲松和甲氧苄啶/磺胺甲噁唑耐药率较高;鲍氏不动杆菌对左氧氟沙星、阿米卡星和甲氧苄啶/磺胺甲噁唑较敏感,肺炎克雷伯菌对阿米卡星、亚胺培南和哌拉西林/他唑巴坦较敏感;感染组患者术后1天、3天和5天血清CRP、IL-1β、IL-6和PCT水平高于未感染组(P<0.05),感染组患者术后3天和5天血清CRP、IL-1β、IL-6和PCT高于术后1天(P<0.05);创伤部位(OR=5.621,95%CI:1.164~27.217,P=0.032)和预防用抗菌药物(OR=5.783,95%CI:1.271~24.741,P=0.021)是骨科患者术后切口感染病原菌属的影响因素。结论骨科患者术后感染伴随炎症因子表达上调,切口细菌感染主要以革兰阴性菌为主,临床治疗应精准到个体患者的药敏特性,并结合患者炎症发作状况,制定合理抗菌和抑炎方案。
OBJECTIVE To investigate the drug susceptibility and inflammatory factors of pathogens of incision infection in orthopedic patients.METHODS Totally 76 patients with orthopedic postoperative incisional infection and 52 patients without incisional infection treated in Ningbo Hospital of traditional Chinese Medicine from Jan.2020 to Jan.2022 were selected as the research subjects,the postoperative infection were analyzed,and the pathogenic bacteria and drug susceptibility were analyzed.The expressions of serum C-reactive protein(CRP),procalcitonin(PCT)and interleukin-6(IL-6)were detected on the 1 st,3 rd and 5 th day after operation.The influencing factors of pathogenic bacteria in postoperative incision infection in orthopedic patients.RESULTS A total of 88 strains of pathogenic bacteria were isolated from 76 cases of incision infection after orthopedic surgery,of which 58 strains of gram-negative bacteria accounted for 65.91%and 30 strains of gram-positive bacteria accounted for 34.09%.There were 10 cases of typeⅠincision,27 cases of typeⅡincision and 39 cases of typeⅢincision.No resistant strains to tegacycline,linezolid,quinoloptin/dafoptin and moxifloxacin were detected.Staphylococcus aureus was sensitive to rifampicin,cefazolin and levofloxacin.Staphylococcus epidermidis was sensitive to vancomycin and gentamicin,Pseudomonas aeruginosa and Escherichia coli were highly resistant to ceftriaxone and trimethoprim/sulfamethoxazole.Acinetobacter baumannii was sensitive to levofloxacin,amikacin and trimethoprim/sulfamethoxazole,while Klebsiella pneumoniae was sensitive to amikacin,imipenem and piperacillin/tazobactam.The serum levels of CRP,IL-1β,IL-6 and PCT in the infected group were higher than those in the uninfected group on the 1 st,3 rd and 5 th day after operation.The levels of CRP,IL-1β,IL-6 and PCT in the infected group on the 3 rd and 5 th day after operation were higher than those on the first day after operation.Wound site(OR=5.621,95%CI:1.164-27.217,P=0.032)and prophylactic antibiotics(OR=5.783,95%CI:1.271-24.741,P=0.021)were the influencing factors of pathogenic bacteria in postoperative infection in orthopedic patients.CONCLUSION Postoperative infection in orthopedic patients was accompanied by up-regulation of the expression of inflammatory factors,and incision bacterial infection was mainly caused by Gram-negative bacteria,the clinical treatment should be accurate to the drug susceptibility characteristics of individual patients,and a reasonable antibacterial and anti-inflammatory plan should be formulated in combination with the patient′s inflammatory state.
作者
林华杰
金甬
贾晋荣
周旭光
胡俊翔
牛丰
邹志强
LIN Hua-jie;JIN Yong;JIAJin-rong;ZHOU Xu-guang;HU Jun-xiang;NIU Feng;ZOU Zhi-qiang(Zhejiang Ningbo Hospital of Traditional Chinese Medicine,Ningbo,Zhejiang 315012,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2022年第20期3132-3136,共5页
Chinese Journal of Nosocomiology
基金
浙江省卫计委基金资助项目(2018ZB119)
国家中医药管理局全国名老中医药专家传承工作室基金资助项目{国中医药人教发([2016]42号)}。
作者简介
林华杰(1985-),男,硕士,副主任医师,研究方向:脊柱外科与创伤骨科疾病。
