8 798例骨科关节手术后感染病原学及耐药性分析

doi:10.12183/j.scjpm.2021.1258

摘要/Abstract

摘要： 目的探讨骨科关节手术后医院感染病原学及耐药性,为临床选取合理抗菌药物提供参考信息。方法采用描述流行病学分析方法对北京市某医院病历管理信息系统中的骨科关节手术后患者病历资料、手术感染情况、感染部位及病原学检测结果进行分析。结果 8 798例骨科关节手术后患者共发现628例医院感染,感染率为7.14%,感染部位以手术切口、上呼吸道、泌尿道为主（78.82%）。628例医院感染患者共检出645株病原菌,含354株革兰阴性菌、248株革兰阳性菌及43株真菌。骨科关节手术后医院感染病原菌构成以大肠埃希菌、铜绿假单胞菌、金黄色葡萄球菌及表皮葡萄球菌为主（68.99%）。大肠埃希菌对氨苄西林、阿米卡星耐药率较高,均超过75%,铜绿假单胞菌、肺炎克雷伯菌对氨苄西林耐药率高达100%; 金黄色葡萄球菌、表皮葡萄球菌对红霉素、青霉素G耐药率高达100%。结论骨科关节手术后患者医院感染不容乐观,主要病原菌为革兰阴性菌,对氨苄西林、头孢曲松耐药率较高,建议临床医师做好围手术期患者病原菌检测及药敏试验,针对性应用抗生素,以最大限度降低骨科关节患者手术后医院感染风险。

关键词: 骨科关节手术, 医院感染, 病原学, 耐药

Abstract: Objective To investigate the etiology and drug resistance of nosocomial infections after orthopedic joint surgery, and to provide reference for clinical selection of reasonable antibacterial drugs. Methods Descriptive epidemiological analysis method was used to analyze the patient's medical records, surgical infection, infection site and etiological test results after orthopedic joint surgery in the medical record management information system of a hospital in Beijing. Results A total of 628 cases of nosocomial infection were found in 8 798 patients after orthopedic joint surgery, and the infection rate was 7.14%. The main infection sites were surgical incision, upper respiratory tract and urinary tract（78.82%）. A total of 645 strains of pathogens were detected in 628 patients with nosocomial infection, including 354 Gram-negative bacteria, 248 Gram-positive bacteria and 43 fungi. The main pathogens of nosocomial infection after orthopedic joint surgery were Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis（68.99%）. The resistance rates of Escherichia coli to ampicillin and amikacin were both higher than 75%, and the resistance rates of Pseudomonas aeruginosa and Klebsiella pneumoniae to ampicillin were as high as 100%. The resistance rates of Staphylococcus aureus and Staphylococcus epidermidis to erythromycin and penicillin G were both 100%. Conclusion Nosocomial infections after orthopedic joint surgery are not optimistic. The main pathogens are Gram-negative bacteria, and the resistance rate to ampicillin and ceftriaxone is relatively high. It is recommended that clinicians do a good job of pathogenic bacteria detection and drug sensitivity test in patients during perioperative period, and targeted application of antibiotics to minimize hospital infections after orthopedic joint surgery.

Key words: Orthopedic joint surgery, Nosocomial infection, Etiology, Drug resistance

中图分类号:

R181.3+2

孟楠,张烁,屈燕馨. 8 798例骨科关节手术后感染病原学及耐药性分析[J]. 华南预防医学, 2021, 47(10): 1258-1261.

MENG Nan, ZHANG Shuo, QU Yan-xin. Etiology and drug resistance analysis of 8 798 cases of infection after orthopedic joint surgery[J]. South China Journal of Preventive Medicine, 2021, 47(10): 1258-1261.

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