目的 研究四肢骨折内固定手术患者术后感染的病原菌特点和耐药情况.方法 收集2013年1月～2016年1月第四军医大学西京医院骨科收治的四肢骨折行内固定术的患者资料,发生术后感染共39例患者,取组织标本进行细菌培养和药敏试验.结果 39例术后感染患者细菌培养阳性率为87.18％(34/39),细菌培养结果阳性的34例患者共分离出38株细菌,4例(10.53％)分离出2种细菌.导致骨折内固定术后感染的病原菌主要为革兰阳性菌(57.89％,22/38),其中,金黄色葡萄球菌(47.36％,18/38)所占比例最高;革兰阴性菌占39.47％,真菌占2.63％.52.63％(20/38)术后感染患者病原菌为多重耐药菌(MDR),70.00％(14/20)的MDR是耐甲氧西林金黄色葡萄球菌,其对青霉素、左氧氟沙星、克林霉素和红霉素等呈较高的耐药性,对万古霉素和利奈唑胺均敏感.结论 骨折内固定术后感染的主要病原菌为金黄色葡萄球菌,且MDR占很高比例.应尽早进行细菌培养和药敏试验明确病原菌,根据药敏试验结果及时调整抗生素使用方案,对降低院内感染发病率、控制抗生素滥用、有效控制感染和提高治愈率有重要意义.%Objective To study the pathogenic characteristics and drug resistance for surgical site infection after limb fracture internal fixation surgery.Methods Data of patients with limb fracture underwent internal fixation in Department of Orthopedics,Xijing Hospital,the Fourth Military Medical University,from January 2013 to January 2016 were selected.39 cases had suffered from postoperative infection.Bacterial cultures and drug sensitive tests were conducted.Results The positive culture rate of 39 patients with infection after surgery was 87.18％ (34/39).Altogether 38 pathogenic strains were cultured from the 34 infected wound,and 2 kinds of bacteria were cultured from 4 patients (10.53％).The pathogenic bacteria causing infection after internal fixation surgery were mainly gram-positive bacteria,which accounted for 57.89％ (22/38) of the total strains.Staphylococcus aureus (47.36％,18/38) was the main pathogenic bacteria.Gram-negative bacteria (39.47％) and fungi (2.63％) were followed.52.63％ (20/38) patients with infection after surgery was multi-drug resistant.The main multi-drug resistant bacteria which caused postoperative infection was methicillin-resistant Staphylococcus aureus,accounting for 70.00％ (14/20).The drug resistance of methicillin-resistant Staphylococcus aureus was relatively high to Penicillin,Levoflox acin,Clindamycin and Ery thromycin,but sensitive to Vancomycin and Linezolid.Conclusion Staphylococcus aureus is the main pathogen causing postoperation infection of the limb fracture internal fixation surgery.The multi-drug resistant organism account for a high proportion.Clarify the pathogens by the bacteria culture and drug sensitive test in the early stage is essential.Adjust the antibiotics according the result of the drug sensitive test can reduce the nosocomial infection control,effectively control the abuse of infection and improve the cure rate.
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