摘要
目的探讨跟骨骨折术后切口感染的病原菌特点及血清白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)水平。方法选择湖州市中心医院和诸暨市人民医院2012年1月—2017年12月跟骨骨折患者300例,采集术后切口部位渗液或分泌物进行病原学及耐药性测定,测定血清IL-2、IL-6、CRP和PCT水平。结果300例跟骨骨折患者中,49例发生术后切口感染,感染率为16.33%。49例术后切口感染患者共培养出病原菌78株,其中革兰阳性菌31株,占39.74%;革兰阴性菌42株,占53.85%;真菌5株,占6.41%。革兰阳性菌以金黄色葡萄球菌为主,占24.36%;革兰阴性菌以大肠埃希菌为主,占29.49%。金黄色葡萄球菌对青霉素G、苯唑西林、氨苄西林、红霉素、环丙沙星耐药率高,耐药率分别为94.74%、89.47%、84.21%、78.95%、73.68%,对万古霉素、替考拉宁、利奈唑胺敏感,耐药率均为0.00%。大肠埃希菌对氨苄西林、头孢唑啉、头孢他啶、头孢吡肟、头孢噻肟耐药率高,分别为100.00%、86.96%、82.61%、78.26%、73.91%,对亚胺培南、美罗培南敏感,耐药率均为0.00%。感染组血清IL-2、IL-6、CRP、PCT水平均高于对照组(t=22.580、48.129、32.237、83.116,均P<0.001)。结论跟骨骨折术后切口感染的病原菌以革兰阴性菌为主,主要病原菌为大肠埃希菌和金黄色葡萄球菌,主要病原菌耐药现象严重,跟骨骨折术后切口感染患者血清IL-2、IL-6、CRP、PCT水平升高。
Objective To investigate the characteristics of pathogenic bacteria and serum IL-2,IL-6,CRP,PCT levels in postoperative wound infection of calcaneal fractures. Methods From January,2012 to December,2017,300 patients with calcaneal fractures in Huzhou Central Hospital and Zhuji People’s Hospital were selected. The etiology and drug resistance of exudates or secretions at the incision site after the acquisition were determined. The serum IL-2,IL-6,CRP and PCT levels were measured. Results In the 300 patients with calcaneal fractures,49 cases had postoperative wound infections,and the infection rate was 16. 33%. A total of 78 strains of pathogenic bacteria were cultivated in 49 cases of postoperative wound infections. There were 31 strains Gram-positive bacteria,accounting for 39. 74%; 42 strains Gramnegative bacteria,accounting for 53. 85%; and 5 strains fungi,accounting for 6. 41%. The gram-positive bacteria were mainly Staphylococcus aureus,accounting for 24. 36%; the Gram-negative bacteria were mainly Escherichia coli,accounting for 29. 49%. The Staphylococcus aureus was highly resistant to penicillin G,oxacillin,ampicillin,erythromycin and ciprofloxacin,the drug resistance rates were 94. 74%,89. 47%,84. 21%,78. 95% and 73. 68%,respectively, the drug resistance rates to vancomycin,teicoplanin and linezolid was 0. 00%. The resistance rates of Escherichia coli to ampicillin,cefazolin,ceftazidime,cefepime and cefotaxime were high,the drug resistance rates were 100. 00%, 86. 96%,82. 61%,78. 26% and 73. 91%,respectively,the drug resistance rates to imipenem and meropenem were 0. 00%. The serum levels of IL-2,IL-6,CRP and PCT in the incision infection group were higher than those in the control group ( t = 22. 580,48. 129,32. 237,83. 116,P < 0. 001) . Conclusion The main pathogens of incision infection after calcaneal fractures are gram-negative bacteria. The main pathogens are Escherichia coli and Staphylococcus aureus. The main pathogens have serious drug resistance. The serum IL-2,IL-6,CRP,PCT levels in patients
作者
罗斌
高志洋
李炜
沈鹏
吴猛
应锦河
LUO Bin;GAO Zhi-yang;LI Wei(Department of Orthopaedics,Huzhou Central Hospital,Huzhou,Zhejiang 313000,China)
出处
《中华全科医学》
2018年第12期2013-2015,2066,共4页
Chinese Journal of General Practice
基金
2014年浙江省卫生厅医药卫生科技计划(2014-KYA232)
