摘要
目的探讨老年股骨骨折患者行内固定术后医院感染因素及病原菌耐药性,为预防老年患者医院感染提供依据。方法选择2011年3月-2014年3月在医院行内固定术的1 500例老年骨折患者作为研究对象,记录患者医院感染率,并对病原菌种类、耐药性以及影响因素进行分析。结果 1 500例患者中发生医院感染45例,感染率为3.0%;医院感染部位主要为呼吸道占36.7%,其次为皮肤软组织占30.0%;45例感染患者中共分离出病原菌97株,其中革兰阳性菌72株占74.2%,主要以金黄色葡萄球菌为主占48.4%,革兰阴性菌20株占20.6%,主要以大肠埃希菌为主占14.4%,真菌5株占5.2%;对革兰阳性球菌耐药率较高的抗菌药物包括青霉素G、红霉素、庆大霉素、左氧氟沙星,对革兰阴性菌耐药率较高的抗菌药物包括头孢他啶、头孢曲松、氨苄西林、头孢唑林、美罗培南;多因素分析显示,住院时间长、围手术期未预防性使用抗菌药物、合并有基础疾病是导致老年骨折患者术后医院感染的独立危险因素(P<0.05)。结论老年股骨骨折患者内固定术后医院感染病原菌主要为革兰阴性菌,住院时间长、围手术期未预防性使用抗菌药物、合并有基础疾病是导致术后医院感染的独立危险因素。
OBJECTIVE To explore the factors and bacterial resistance of nosocomial infections following internal fixation for intertrochanteric fracture in elderly patients.METHODS A total of 1 500 cases of elderly patients with femoral intertrochanteric fracture treated in our hospital from Mar.2011 to Mar.2014 were selected as the research subjects.The nosocomial infection rate was recorded,and the infectious pathogens,drug resistance of bacteria and influencing factors were analyzed.RESULTS In 1 500 patients,nosocomial infections occurred in 45 cases,the nosocomial infection rate was 3.0%.The main sites of nosocomial infections were respiratory tract（36.7%）,followed by skin and soft tissues（30.0%）.Totally 97 strains of pathogenic bacteria were isolated from45 patients,including 72 strains of gram positive bacteria accounting for 74.2%,mainly Staphylococcus aureus（48.4%）;20strains of gram negative bacteria accounting for 20.6%,mainly Escherichia coli（14.4%）;and 5strains of fungi accounting for 5.2%.gram-positive bacteria had relatively high resistant rate to penicillin G,erythromycin,gentamicin,levofloxacin;gram-negative bacteria had relatively high resistant rate to ceftazidime,ceftriaxone,ampicillin,cefazolin,and meropenem.The multivariate analysis showed that duration of hospitalization,no prophylactic use of antimicrobial drugs and complication of underlying diseases were independent risk factors for nosocomial infections following internal fixation in elderly patients with femoral intertrochanteric fracture（P〈0.05）.CONCLUSIONThe main pathogenic bacteria of nosocomial infections following internal fixation in elderly patients with femoral intertrochanteric fracture are gram positive bacteria.Duration of hospitalization,no prophylactic use of antimicrobial drugs and complication of underlying diseases are independent risk factors for nosocomial infections.
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2015年第4期888-890,共3页
Chinese Journal of Nosocomiology
基金
天津市卫生局重点基金资助项目(TW-2010B-037)
关键词
股骨骨折
老年患者
内固定
医院感染
耐药性
Femoral intertrochanteric fracture
Elderly patients
Internal fixation
Nosocomial infection
Drug resistance
