摘要
目的评估老年胸腰椎骨折术后早期切口感染病原菌分布特点以及危险因素探讨研究。方法选取2017年1~12月行内固定术的老年胸腰椎骨折患者150例。按照患者术后是否早期感染分为感染组和非感染组,其中感染组29例,非感染组121例。分析感染患者病原菌构成比,主要病原菌耐药性,早期切口感染的危险因素和感染率,通过多因素logistic回归分析引发早期切口感染的独立危险因素。观察比较2组患者术后免疫指标IgA,IgE,IgG1,IgG2以及IgG水平情况。结果150例患者发生早期感染29例,检出病原菌45株,其中革兰阳性菌为15株(33.33%),以金黄色葡萄球菌为主(20.00%);革兰阴性菌为28株(62.22%),以铜绿假单胞菌为主(28.89%);真菌为2株(4.44%)。金黄色葡萄球菌对青霉素、四环素耐药性最高,铜绿假单胞菌对氨苄西林的耐药性最高。年龄≥60岁、手术时间长、完全骨折、合并有糖尿病、无指征使用抗菌药物患者感染率明显更高(P<0.05)。经多因素logistic回归分析,年龄≥50岁、手术时间长、完全骨折、合并有糖尿病、无指征使用抗菌药物均为引发老年胸腰椎骨术后早期切口感染的独立危险因素(P<0.05)。结论老年胸腰椎骨折术后早期切口感染患者多以铜绿假单胞菌、金黄色葡萄球菌为主,感染率高,临床治疗应对独立危险因素进行针对性的防治,以降低术后早期切口感染率,提高免疫水平,改善预后。
Objective To investigate the distribution characteristics of pathogens and risk factors of early incision infection after surgery in elderly patients with thoracolumbar fracture.Methods A total of 150 elderly patients with thoracolumbar fractures who underwent internal fixation in our hospital from January 2017 to December 2017 were enrolled in the study.According to whether the patients were infected at early period or not,who were divided into infection group(n=29)and non infection group(n=121).The constituent ratio of pathogenic bacteria,the drug resistance of the main pathogens,the risk factors of early incisional infection and the infection rate were analyzed,and the independent risk factors for early infection of incision were analyzed by multiple factor Logistic regression analysis.Moreover the levels of IgA,IgE,IgG1,IgG2 and IgG after operation were observed and compared between the two groups.Results Among the 150 patients,there were 29 cases of early infection,of whom,45 strains of pathogenic bacteria were detected,including 15 strains of Gram-positive bacteria,accounting for 33.33%,mainly Staphylococcus aureus(20.00%),and 28 strains of Gram-negative bacteria,accounting for 62.22%,mainly Pseudomonas aeruginosa(28.89%)and 2 strains of fungi,accounting for 4.44%.Staphylococcus aureus had the highest resistance to penicillin and tetracycline,and Pseudomonas aeruginosa had the highest resistance to ampicillin.The results showed that the infection rate of patients with age over 60 years,longer operation time,complete fracture,combined with diabetes,and no indication of antibiotics medication was significantly increased(P<0.05).Multifactor logistic regression analysis showed that the patient’s age≥50 years,longer operation time,complete fracture,combined with diabetes,and no indication of antibiotics medication were independent risk factors for early postoperative incision infection in elderly patients with thoracolumbar fractures after surgery(P<0.05).Conclusion The early incision infection in elderly patients with thoracolumbar fractures after surgery are mainly Pseudomonas aeruginosa and Staphylococcus aureus,and the infection rate is higher,therefor,it is necessary to prevent and control the independent risk factors in order to reduce the early postoperative infection rate,improve the immune levels and the prognosis of patients.
作者
王玲娟
刘艳武
董婷婷
胡学昱
冯大鹏
WANG Lingjuan;LIU Yanwu;DONG Tingting(Department of Osteology,The First Hospital Affiliated to Air Force Military Medical University of PLA,Shaanxi,Xi’an 710032,China)
出处
《河北医药》
CAS
2020年第16期2493-2496,共4页
Hebei Medical Journal
基金
国家自然科学基金资助项目(编号:81572151)。
关键词
老年胸腰椎骨折
早期切口感染
病原学特点
危险因素
elderly thoracolumbar fractures
early incision infection
etiological characteristics
risk factors
