胫腓骨开放性骨折术后并发感染的危险因素及耐药性分析

摘要

目的：探讨胫腓骨开放性骨折术后并发感染的危险因素及分析各种病原菌的耐药性。方法收集胫腓骨开放性骨折患者106例，患者均采集标本进行细菌培养，分析各病原菌的耐药性和感染的相关因素。结果106例术后继发性感染标本共分离获得142株病原菌，占比最高为大肠埃希菌。产ESBLs菌株中，大肠埃希菌有28株。大肠埃希菌对氨苄西林的耐药性最高；铜绿假单胞菌对氨苄西林、头孢唑林的耐药性最高；褪色沙雷菌对氨苄西林的耐药性最高。凝固酶阴性葡萄球菌对青霉素G耐药性最高。106例术后继发感染患者中，感染原因为切口闭合不当者感染率为60.4%；骨折固定方式不当者感染率为24.5%；止血不充分者感染率为3.8%；引流不畅感染率为4.7%；受伤至手术时间过长感染率为2.8%；清创不彻底、遗留手术物品感染率均为1.9%；切口闭合不当者感染发生率明显高于其他原因(P<0.05)。结论对胫腓骨开放性骨折，手术过程中需严格无菌操作，缩短切口暴露时间，缝合切口前使用抗菌药物。术后合理使用抗菌药预防感染，尽可能减少患者患者过度活动，切口保湿，抬高患肢等均可降低感染的风险。对那些感染可疑者进行细菌培养和药敏试验，根据结果选用合适的药物治疗。%Objective To study the risk factors of postoperative infection in open fracture of tibia and ifbula and analyze the drug resistance of various pathogenic bacteria.Methods 106 patients with open fractures of tibia and ifbula were collected. Specimen of all patients were collected for bacterial culture, and the related factors of infection and drug resistance were analyzed.Results 106 specimen of secondary infection after surgery were isolated 142 strains of pathogenic bacteria, Escherichia coli was accounting for the highest proportion. Among producing ESBLs strains, there were 28 escherichia coli strains. the drug resistance of Escherichia coli to ampicillin was the highest; the drug resistance of Pseudomonas aeruginosa to ampicillin and cefazolin was the highest; the drug resistance of fading serratia to ampicillin was the highest. the drug resistance of Coagulase negative Staphylococcus to penicillin G was the highest drug. Among 106 infected patients, the infection rate because of improper wound closure was 60.4%, the infection rate because of ifxation of fracture was improper was 24.5%, the infection rate because of bleeding was 3.8%, the infection rate because of the time from injury to operation being longer was 2.8%, the infection rate because of nondebridement or left surgical items was 1.9%, the infection rate because of improper wound closure was higher than other reasons (P<0.05).Conclusion In open fracture of tibia and ifbula, During operation process should be strictly aseptic operation, shorten wound exposure time, using antibacterial drugs before suture incision. The rational use of antibiotics to prevent infection, as far as possible to reduce patients with excessive activity, wound moisture, and raise the affected limb, can reduce the risk of infection. For those infected with suspected bacterial culture and drug sensitivity test, according to the resultsof the selection of appropriate drug treatment.