本文選題：骨科植入 + 醫(yī)院感染��； 參考：《中華醫(yī)院感染學(xué)雜志》2017年18期

【摘要】：目的探討骨科植入術(shù)后醫(yī)院感染病原菌特點(diǎn)及危險(xiǎn)因素分析。方法選擇醫(yī)院于2014年12月-2016年12月收治的行骨科植入術(shù)患者1437例。采集患者痰液、尿液、血液標(biāo)本,分離培養(yǎng)細(xì)菌,其中革蘭陽(yáng)性菌藥敏試驗(yàn)采用GN201法,革蘭陰性菌藥敏試驗(yàn)采用GP法,以紙片擴(kuò)散法進(jìn)行藥敏試驗(yàn)�；仡櫺苑治龌颊吲R床資料,內(nèi)容包括性別、年齡、手術(shù)類(lèi)型、氣壓止血時(shí)間、術(shù)中應(yīng)用大功率電刀、術(shù)后PVP碘紗布貼傷口。結(jié)果骨科植入術(shù)患者1437例,術(shù)后發(fā)生醫(yī)院感染患者66例,感染率為4.59%;66例術(shù)后醫(yī)院感染患者中,30例發(fā)生切口感染占45.45%;呼吸道感染16例占24.24%,泌尿道感染12例占18.18%,其他8例占12.12%;術(shù)后醫(yī)院感染66例患者共分離培養(yǎng)病原菌80株,其中革蘭陰性菌48株占60.00%,革蘭陽(yáng)性菌30株占37.50%,真菌2株占2.50%;主要革蘭陰性菌銅綠假單胞菌對(duì)阿莫西林和頭孢曲松耐藥率較高,分別為90.48%和80.95%;鮑氏不動(dòng)桿菌對(duì)阿莫西林、美羅培南、頭孢他啶、阿米卡星等耐藥率較高,分別為91.67%、8.33%、83.33%、75.00%;主要革蘭陽(yáng)性菌金黃色葡萄球菌對(duì)青霉素、紅霉素、環(huán)丙沙星耐藥率較高,分別為100.00%、85.71%、78.57%;表皮葡萄球菌對(duì)紅霉素和青霉素耐藥率較高,分別為100.00%和90.91%;單因素分析表明,性別、年齡、手術(shù)類(lèi)型比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);氣壓止血時(shí)間≥90min、術(shù)中應(yīng)用大功率電刀及術(shù)后PVP碘紗布貼傷口具有統(tǒng)計(jì)學(xué)差異(P0.05);將單因素分析中具有統(tǒng)計(jì)學(xué)差異的納入多因素分析表明,氣壓止血時(shí)間≥90min、術(shù)中應(yīng)用大功率電刀及術(shù)后PVP碘紗布貼傷口為術(shù)后發(fā)生醫(yī)院感染的獨(dú)立危險(xiǎn)因素。結(jié)論骨科植入術(shù)后醫(yī)院感染患者以手術(shù)切口感染為主,病原菌以革蘭陰性菌為主,氣壓止血時(shí)間≥90min、術(shù)中應(yīng)用大功率電刀及術(shù)后PVP碘紗布貼傷口為術(shù)后發(fā)生醫(yī)院感染的危險(xiǎn)因素,應(yīng)合理應(yīng)用抗菌藥物及針對(duì)危險(xiǎn)因素采取相應(yīng)預(yù)防措施。
[Abstract]:Objective to investigate the characteristics and risk factors of nosocomial infection after orthopedic implantation. Methods 1437 orthopaedic implants were selected from December 2014 to December 2016. The sputum, urine and blood samples of patients were collected and the bacteria were isolated and cultured. The drug sensitivity test of Gram-positive bacteria was performed by GN201 method, the susceptibility test of Gram-negative bacteria by GP method, and the drug sensitivity test by disk diffusion method. The clinical data of the patients were analyzed retrospectively, including sex, age, type of operation, time of pneumatic hemostasis, application of large power electric knife during operation and application of PVP iodine gauze after operation. Results there were 1437 cases of orthopedic implants and 66 cases of postoperative nosocomial infection. The infection rate was 4.590.30 of 66 patients with postoperative nosocomial infection had incision infection (45.45%), 16 patients had respiratory tract infection (24.24cm), 12 patients had urinary tract infection (18.1818) and the rest 8 patients (12.12%), 66 patients with postoperative nosocomial infection had isolated and cultured 80 strains of pathogenic bacteria. Among them, 48 strains of Gram-negative bacteria accounted for 60.00m, 30 strains of Gram-positive bacteria accounted for 37.50, 2 strains of fungi accounted for 2.50.The resistance rates of the main gram-negative bacteria Pseudomonas aeruginosa to amoxicillin and ceftriaxone were 90.48% and 80.95%, respectively, and Acinetobacter baumannii to amoxicillin, The drug resistance rates of meropenem, ceftazidime and amikacin were 91.67 and 8.33 and 83.33, respectively. The main gram-positive bacteria Staphylococcus aureus showed higher resistance to penicillin, erythromycin and ciprofloxacin. The resistance rates of Staphylococcus epidermidis to erythromycin and penicillin were 100.00% and 90.91%, respectively. There was no significant difference in the type of operation (P 0.05), the time of hemostasis was more than 90 min, the application of high power electric knife during operation and the application of PVP iodine gauze to the wound after operation had statistical difference (P 0.05), and the multivariate analysis showed that there were statistical differences in single factor analysis. The blood pressure hemostasis time was more than 90 min, the application of high-power electric knife and postoperative PVP iodine gauze sticking wound were the independent risk factors of nosocomial infection. Conclusion the nosocomial infection after orthopedic implantation is mainly caused by incision infection and Gram-negative bacteria. The hemostasis time of air pressure 鈮，

本文編號(hào)：1972012