2012 年至 2017 年骨科医院感染病原菌耐药性分析：6 年回顾性研究。
Drug resistance of pathogens causing nosocomial infection in orthopedics from 2012 to 2017: a 6-year retrospective study.
机构信息
Department of Orthopedics, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China.
Department of Laboratory, First Affiliated Hospital of Nanchang University, No. 17 Yong Wai Zheng Street, Nanchang, 330006, Jiangxi, China.
出版信息
J Orthop Surg Res. 2021 Feb 1;16(1):100. doi: 10.1186/s13018-021-02234-7.
BACKGROUND
Hospital-acquired infections (HAIs) are an emerging global problem that increases in-hospital mortality, length of stay, and cost. We performed a 6-year retrospective study to provide valuable insight into appropriate antibiotic use in HAI cases. We also aimed to understand how hospitals could reduce pathogen drug resistance in a population that overuses antibiotics.
METHODS
All data (2012-2017) were obtained from the hospital information warehouse and clinical microbiology laboratory.
RESULTS
We isolated 1392 pathogen strains from patients admitted to the orthopedics department during 2012-2017. Escherichia coli (14.7%, 204/1392), Enterobacter cloacae (13.9%, 193/1392), and Staphylococcus aureus (11.3%, 157/1392) were the most common pathogens causing nosocomial infections. The dominant Gram-negative bacterium was E. coli, with high resistance to ampicillin, levofloxacin, cotrimoxazole, gentamicin, and ciprofloxacin, in that order. E. coli was least resistant to amikacin, cefoperazone-sulbactam. The most dominant Gram-positive bacterium was S. aureus, highly resistant to penicillin and ampicillin, but not resistant to fluoroquinolones and cotrimoxazole. Analysis of risk factors related to multidrug-resistant bacteria showed that patients with open fractures (Gustillo III B and IIIC) were significantly more susceptible to methicillin-resistant S. aureus infections (p < 0.05). Additionally, extended-spectrum β-lactamase-producing E. coli infections occurred significantly more often in patients with degenerative diseases (p < 0.05). Elderly patients tended to be more susceptible to multidrug-resistant bacterial infections, but this outcome was not statistically significant.
CONCLUSIONS
Antimicrobial resistance is a serious problem in orthopedics. To effectively control antimicrobial resistance among pathogens, we advocate extensive and dynamic monitoring of MDR bacteria, coupled with careful use of antibiotics.
背景
医院获得性感染（HAI）是一个日益严重的全球问题，它会增加住院死亡率、住院时间和医疗成本。我们进行了一项为期 6 年的回顾性研究，旨在深入了解 HAI 病例中抗生素的合理使用。我们还旨在了解医院如何在过度使用抗生素的人群中降低病原体的药物耐药性。
方法
所有数据（2012-2017 年）均从医院信息仓库和临床微生物学实验室获得。
结果
我们从 2012-2017 年期间骨科住院患者中分离出 1392 株病原体。大肠埃希菌（14.7%，204/1392）、阴沟肠杆菌（13.9%，193/1392）和金黄色葡萄球菌（11.3%，157/1392）是引起医院感染最常见的病原体。主要革兰阴性菌是大肠埃希菌，对氨苄西林、左氧氟沙星、复方新诺明、庆大霉素和环丙沙星的耐药性依次增高。对阿米卡星、头孢哌酮舒巴坦的耐药性最低。主要革兰阳性菌是金黄色葡萄球菌，对青霉素和氨苄西林高度耐药，但对氟喹诺酮类和复方新诺明耐药。对与多重耐药菌相关的危险因素分析表明，开放性骨折（Gustillo III B 和 IIIC）患者感染耐甲氧西林金黄色葡萄球菌的风险显著增加（p<0.05）。此外，在退行性疾病患者中，产超广谱β-内酰胺酶的大肠埃希菌感染明显更为常见（p<0.05）。老年患者易发生多重耐药菌感染，但无统计学意义。
结论
抗生素耐药性是骨科的一个严重问题。为了有效控制病原体的抗生素耐药性，我们主张广泛和动态监测 MDR 细菌，并谨慎使用抗生素。
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