摘要
目的探讨四肢创伤性骨折术后Gram阳性和阴性细菌感染的地域性分布态势及耐药率，旨在为手术前、后经验性使用抗菌素提供循证医学依据。方法回顾性分析筛查2012年1月至2015年1月因四肢创伤性骨折住院治疗的3728例患者，按照CLSIM．100-S22标准，收集经手术、病理及细菌培养证实细菌感染的51例患者的病历资料，整理其病理、窦道分泌物或病灶穿刺标本的细菌培养和药敏试验数据，对金黄色葡萄球菌（S．aureus）等主要菌株的分布及耐药性进行分析。结果四肢创伤性骨折术后细菌感染率为1．37％（51／3728）。常见感染骨折部位依次为胫腓骨（25例，49．02％）、股骨（11例，21．57％）、尺桡骨（8例，15．69％）。单株菌感染45例（88．23％），混合感染6例（11．76％）。Gram阳性细菌感染以S．aureus（27例，47．37％）、表皮葡萄球菌（4例，7．02％）、鸟肠球菌（2例，3．51％）为主；Gram阴性细菌感染以大肠埃希菌（E．coli）（9例，15．79％）、阴沟肠杆菌（4例，7．02％）、肺炎克雷伯氏菌（2例，3．51％）为主。药敏试验发现主要Gram阳性菌耐药率为40．74％-100．00％，以耐林可霉素、红霉素、青霉素、四环素、头孢西丁和苯唑西林为主，未检出对万古霉素、替加环素、呋喃妥因耐药的S．aureus、表皮葡萄球菌和鸟肠球菌。主要Gram阴性细菌耐药率为44．44％～100．00％，以耐左氧氟沙星、氨苄西林、氨曲南、头孢曲松、头孢替坦、头孢他啶等为主，未检出对亚硫胺霉素耐受的主要Gram阴性菌。S．aureus感染的27例患者中耐甲氧西林金黄色葡萄球菌（MRSA）占11例（40．74％），全部对吗啉恶酮、氨苄西林、替加环素、万古霉素等敏感。结论创伤性四肢骨折术后感染以下肢长骨和尺桡骨感染单株S．aureus、E．coli、表皮葡萄球菌或阴沟肠杆菌为主，有明显�
Objective To investigate regional characteristics of postoperative Gram-positive/nega- tive bacterial infection and antibiotic resistance following traumatic limb fracture patients in Southwest of China, and to provide evidence-based guidelines for empiric antibiotic therapy. Methods All human subject studies were performed using protocols approved by the institutional review board. A retrospective chart review was performed of 3, 728 medical records of the patients who had been treated for extremity traumatic fracture from January 2012 to January 2015. Included in the present study were 51 patients whose os- teomyelitis had been confirmed by Gram-positive/negative bacterial infections, and susceptibility data deter- mined by the M-100-$22 protocol （Clinical ＆ Laboratory Standards Institute（CLSI） 2012 USA）. The data of fracture type with Gram-positive/negative, MRSA（methicillin-resistant S. aureus）/MSSA （methicillin-susceptible S. aureus） distribution and antibiotic resistance were analyzed. Results The overall postoperative infection rate was 1.37% （51/3,728）. In the 51 osteomyelitis patients： the most common fracture sites were tibia-fibula （25 cases, 49.02% ）, femur （11 cases, 21.57% ） and radius-ulna（8 cases, 15.69% ） . Monomicrobial infection was found in 45 cases of them （88.23%） and polymicrobial infection in 6（11.76% ） . The Gram-positive infections were caused by S. anreus （27 cases, 47.37% ）, S. epidermidis （4 cases, 7.02% ） and Enteroceecus avium （2 cases, 3.51% ） and the Gram-negative infections mainly by E. coli （9 cases, 15.79% ）, E. cloacae （4 cases, 7. 02% ）, and Klebsiella pneumonia （2 cases, 3.51% ）. The antibiotic resistance by the Gram-positive bacteria was observed in penicillin and erythromyciu （100%）, lincomycin （51.86% by S. aureus, 75% by S. epidermidis, and 50% by Enterococcus avium）, tetracycline （40. 74% by S. aureus, and 50% by S. epidermidis ＆ Enterococcus avium）, cefoxitin （40. 74% by S. aureus, and
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2016年第3期226-232,共7页
Chinese Journal of Orthopaedic Trauma
基金
国家自然科学基金（81260280）
AO临床优先项目（416331-G）
关键词
感染
骨折
葡萄球菌
金黄色
耐药性
Infection
Fractures, bone
Staphylococcus aureus
Antibiotic resistance
