Study On Bacterial Infection In Patients With Open Fracture Surgery Of The Seventh People's Hospital In Zibo

Objective:To identify the bacterial types and species in patients with open fracture surgery by investigating the position and incidence rate of bacterial infection.It also aims to analyze the antibiotic susceptibility of pathogens obtained in this study and to evaluate the risk factors of infection in patients with open fracture surgery.Methods : A total of 791 patients with open fracture,who were admitted to the Orthopaedic Department of the Seventh People's Hospital in Zibo from January 2016 to December 2018,were selected by using simple random sampling method.Furthermore,the patients were divided into control group(without infection)and observation group(with infection)depending on whether there was bacterial infection after operation.The bacterial infection position of the patients in the observation group was recorded.The samples of purulent secretions,sputum,urine and blood from incisions of patients with bacterial infections were collected,and the specimens were cultured in culture medium.Bacterial identification instrument was used to identify pathogenic bacteria and conduct antibiotic susceptibility analysis,and paper disc diffusion method was added to perform antibiotic susceptibility analysis.Besides,the questionnaire involving clinical data was designed and distributed to patients in two groups who were required to fill in the questionnaire according to their actual situation,followed by the integration and analysis of the relevant data after completing recording.The questionnaire included demographic data,complications,fracture location,treatment situation and application of antibiotics.Finally,logistic regression analysis was conducted to assess the risk factors of infection in patients with open fracture surgery.Results: The infection rates of patients who had received open fracture surgery were 23.4%(58/248)in 2016,24.5%(65/265)in 2017 and 25.5%(71/278)in 2018,respectively.There was no statistically significant difference in the infection rates of patients with open fracture in different years(P > 0.05).Also,surgical site infection was the most common infection,accounting for 58.6%,66.2% and 66.2%,respectively,in2016,2017 and 2018.Tibia and fibula were the main locations of infection in operation sites,accounting for 64.7%,65.1% and 63.8%,respectively.A total of 329 strains ofpathogenic bacteria were detected in the observation group,of which 102 strains were detected in patients with infection in 2016,112 strains in 2017 and 115 strains in 2018.The most frequently identified bacteria from 2016 to 2018 were Gram-negative bacteria,accounting for 47.1%,50.0% and 49.6%,respectively.The antibiotic susceptibility analysis showed that the resistance rate of the main Gram-negative bacteria to imipenem,ampicillin / sulbactam,levofloxacin,amikacin,compound xinuoming and ciprofloxacin was low,the resistance rate of main Gram-positive bacteria to tetracycline,rifampin,tetracycline,moxifloxacin and linezolid was low.There was statistically significant difference between the control group and the observation group in age,diabetes mellitus,fracture location,operation time,intraoperative bleeding volume,invasive operation,indwelling time of drainage tube,hospitalization time and allogeneic blood input(P<0.05).Furthermore,logistic regression analysis showed that independent risk factors for postoperative infection in the observation group included age?60 years old,diabetes mellitus,fracture of lower limbs and waist and hip,operation time ? 2 hours,intraoperative bleeding?300 mL,invasive operation,indwelling time of drainage tube?3 days,hospitalization time?14 days and allogeneic blood transfusion.Conclusion: Our study in Zibo shows that Bacterial infection in patients with open fracture remains relatively frequent,with the most common infection in surgical site,and the incidence of infection of tibia and fibula fractures is high.The gram-negative bacteria are the most frequently identified bacteria that cause infection in patients with open fracture surgery.All pathogenic bacteria studied have obvious resistance to antibiotics,making it necessary to administer antibiotics according to the results of antibiotic susceptibility analysis.Even more,it is essential to strengthen the awareness of prevention of infection for high-risk patients.