| Objective:Analysis of several medical institution in Shanxi infection in patients with chronic osteomyelitis pathogenic bacteria distribution and drug resistance and infection risk factors,,provide theoretical support for clinical antibiotic treatment,chronic osteomyelitis of infection prevention and control strategy for Shanxi Province to provide reasonable basis.Methods:The clinical data of 421 patients with chronic osteomyelitis diagnosed from January 1,2016 to December 31,2021 were retrospectively analyzed:Collect the basic information,hospitalization information,infection status,bacterial culture results and other data of patients with chronic osteomyelitis,and statistically describe the detection,distribution and changes of infectious pathogens;According to the results of bacterial culture,the drug resistance of the main gram-positive bacteria and the main gram-negative bacteria was analyzed;Multivariate risk factor analysis was performed in patients with positive bacterial culture of chronic osteomyelitis.Results:1.Detection and distribution of pathogenic bacteria in chronic osteomyelitis:A total of 421 patients with chronic osteomyelitis were included between January 2016 and December 2021 and 386 strains of 74 kinds of pathogenic bacteria were isolated.The positive rate of culture was 69.36%.The negative rate of culture was 30.64%.There was a positive correlation between age and the positive rate of culture.The older the age,the higher the positive rate of culture.The positive rate of culture was the highest(72.81%)in the age of 60 and above.The detection rate of multi-drug resistant bacteria was 44.04%(170/386).84.56%(356/421)of the patients had a single infection site.244 strains(63.21%)of 41 species of Gram-positive bacteria,139strains(36.01%)of 33 species of Gram-negative bacteria and 3 strains(0.78%)of fungi were detected.The first pathogen detected was Staphylococcus aureus(132strains,34.20%),followed by coagulase-negative Staphylococcus(47 strains,12.18%),Enterobacter(25 strains,6.47%),Pseudomonas(24 strains,6.22%),Enterococcus(22 strains,5.70%),Streptococcus(22 strains,5.70%),Escherichia coli(21 strains,5.44%)and other species(93 strains,24.09%).2.Drug resistance of pathogenic bacteria of chronic osteomyelitis infection:Among Gram-positive bacteria,Staphylococcus,MSSA,MRSA,Co NS and enterococcus have high drug resistance rate to traditional antibacterial drugs such as penicillin,erythromycin and clindamycin,with the highest resistance rate reaching 100%,and have high drug sensitivity to peptides and oxazolidinone,such as vancomycin,linezolid and teicoplanin.Among gram-negative bacteria,the resistance rates of Enterobacter,Pseudomonas and Escherichia coli to the first and second generation cephalosporins were higher than those to the third and fourth generation cephalosporins,the resistance rates to cephalosporins combined with enzyme inhibitors were lower than those to cephalosporins alone,and the resistance rates to carbapenems such as imipenem and meropenem were low.3.Analysis of risk factors for chronic osteomyelitis infection:Univariate analysis showed that infection was associated with diabetes mellitus,hypertension,smoking history,trauma history and length of hospital stay(P <0.05).Multivariate Logistic regression analysis showed that length of hospital stay(OR=1.037,P=0.001<0.05),diabetes mellitus(OR=6.61,P =0.049 <0.05)and smoking(OR=6.873,P=0.003 <0.05)were independent risk factors for infection.Conclusion:1.From 2016 to 2021,Gram-positive bacteria were still the main pathogens of chronic osteomyelitis infection,and the top four pathogens were:Staphylococcus aureus,coagulase-negative staphylococci,Enterobacteriaceae,and Pseudomonas.2.Staphylococcus aureus is still the main pathogen of chronic osteomyelitis infection,but the infection rate showed a downward trend;Methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus infection rate showed an upward trend.It is necessary to continue to monitor the change of pathogenic bacteria.3.Gram-positive bacteria and Gram-negative bacteria showed different degrees of resistance to most antibiotics.Gram-positive bacteria had high resistance to traditional antibiotics such as penicillin and erythromycin,and high sensitivity to antibiotics such as linezolid and vancomycin.Gram-negative bacteria had higher resistance to the first and second generation cephalosporins than the third and fourth cephalosporins.4.Length of hospital stay,smoking and diabetes mellitus were independent risk factors for chronic osteomyelitis infection.Effective management of these factors should be combined with clinical practice to prevent and control the infection of chronic osteomyelitis. |
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