| BackgroundSurgical site infection(SSI)is one of the severest complications in orthopedics.It is estimated that the prevalence of SSI in the USA hospitals is approximately 1.07%.Delayed diagnosis and treatment would prolong the length of stay of inpatients,increase the use of antibiotics,rates of revision surgery and follow-up periods of outpatients,and also affect the recovery of limb function which adds a burden for patients.These problems are still not solved and are also challenges to surgeon.We found that factors influencing SSI include physical status of patients,operation,nursing techniques,implants implantation,environment and monitoring measures through reviewed literatures.However,several factors are still under controversial and lack of abundant clinical evidences.Objective1.To identify the prevalence of SSI,pathogenic characteristics and drug resistance of SSI and provide the data for clinical use of antibiotics in early stage which contributes to reduce antibiotics misuse and control the development of infection and help to increase the cure rate through retrospective analysis of patients after fracture open reduction and internal fixation surgery in orthopedics.2.To analyze the risk factors of patient infection,control the controllable factor and provide the evidence for the SSI prevention through conducted control studies with patients treated with same surgery in orthopedics but SSI hasn't occurred.Methods1.We selected patients who had SSI after internal fixation surgery for limb fracture in Xijing hospital from January 2013 to January 2016 according to inclusive and exclusive criteria and calculated the prevalence of SSI of the department of orthopedic.The secretion from infected wounds was cultured to identify pathogens,pathogenic characteristics,distribution of multidrug resistant bacteria and resistance of pathogens.2.We selected patients who had SSI after surgery as infected groups.For each infected case,2 non-infected controls were selected from the same period and database of all patients who underwent the same type surgery and whose main diagnosis and surgical methods are matched with infected group.The general condition and surgery related factors were collected and analyzed.The results of investigation were analyzed with t-test or c2 test,and statistically significant risk factors were evaluated and tested by regression model and then were analyzed by Logistic regression analysis.Results1.There were 4125 patients underwent internal fixation surgery for limb fracture in the department of orthopedics of Xijing hospital from January 2013 to January 2016,among whom 39 cases have SSI.Incidence of SSI among male was far beyond that among female.The prevalence was 0.95%.The positive culture rate of 39 patients with infection after surgery was 87.18%(34/39),and 5 samples were negative.Altogether 38 pathogenic strains were cultured from the 34 infected samples.4 patients(10.53%)cultured 2 types of bacteria,belongs to the mixed infection.Lower limb incidence was significantly higher than other parts,including tibia and fibula fracture in 24 cases,accounting for 61.53%,femoral fractures in 11 cases,accounting for 28.21%.The pathogenic bacteria causing infection after internal fixation surgery were mainly gram-positive bacteria,accounting for 57.89%(22/38)of the total strains,the main pathogenic bacteria were staphylococcus aureus(18/38,47.36%).Gram-positive bacteria(15/38,39.47%)and fungi(1/38,2.63%)were followed.The strains causing postoperative infection were mainly multi-drug resistant bacteria,accounting for(20/38,52.63%)of which were methicillin-resistant Staphylococcus aureus(14/20,70.00%).The drug resistance of methicillin-resistant Staphylococcus aureus was relatively high to penicillin,levofloxacin,clindamycin and erythromycin,but sensitive to vancomycin and linezolid.The remaining MDRs were ESBLs-producing Escherichia coli(3/20,15.00%),Acinetobacter baumannii(2/20,10.00%)and Pseudomonas aeruginosa(1/20,5.00%).2.28 patients were male among 39 cases and their ages were from 21 to 73 during the first surgery.Mean age of them was 44.2 years old,and average BMI(body mass index)was 25.6 kg/m2.Univariate analysis revealed that the factors impacting the SSI was patients complicated with underlying diseases,the time interval from injury to surgery ? 8h,open fracture,multiple fracture,time of operation ? 180 min,duration of drainage ? 3d and average hospitalization time ? 14 d.Results were significant compared with the cases in the control group(P<0.05).Multivariate Logistic analysis showed that the time interval from injury to surgery,open fracture,time of operation,duration of drainage and average hospitalization time were independent risk factors for SSI after internal fixation surgery for limb fracture(P<0.05),OR and 95% CI were 7.454(1.463~37.976),3.706(1.160~11.842),6.474(1.405~29.824),4.310(1.296~14.326),8.064(1.848~35.179)respectively.Conclusion1.Gram-positive bacteria is the main pathogen causing SSI of the limb fracture internal fixation surgery,and the Staphylococcus aureus is the most common.The multidrug resistant organism account for a high proportion.For the patients suspected of SSI,we should clarify the pathogen through the bacterial culture and antimicrobial susceptibility test as early as possible,and adjust the antibiotics in time.2.For SSI after fracture open reduction and internal fixation surgery,independent risk factors include interval from injury to surgery,open fracture,time of operation,duration of drainage and average hospitalization time.Monitoring the related risk factors is essential.Surgery is needed as soon as possible for the patients with open fracture and the long interval from injury to surgery after relative examinations.Minimizing the duration of drainage and average hospitalization time is in favor of lowering the prevalence of SSI of patients underwent internal fixation surgery for limb fracture. |
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