糖尿病患者骨科手术后感染病原菌及其危险因素

Analysis of pathogenic bacteria and risk factors for postoperative infection in patients with diabetes undergoing orthopedic surgery

    摘要
  • 摘要:
    目的 探究糖尿病患者骨科手术后感染病原菌，并分析术后感染的危险因素。
    方法 选取2023年1月-2024年12月于广西医科大学第二附属医院进行骨科手术治疗的140例糖尿病患者，根据术后感染情况，分为感染组(n=24)和非感染组(n=116)，比较两组患者性别、年龄、体质量指数、血糖水平、手术时间、手术方式、切口长度等指标，并进行logistic回归分析，探究糖尿病患者骨科手术后感染的危险因素；对感染菌株和炎性因子白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)水平进行检测。
    结果 140例患者中，有24例患者出现术后感染，发生率为17.14%(24/140)，且患者以切口感染为主，占比45.83%，其IL-6、TNF-α、CRP水平分别为(2.71±0.43)ng/ml、(9.71±1.58)ng/ml和(11.62±1.35)mg/L高于非感染组(P＜0.05)；糖化血红蛋白水平(OR=5.987)和切口类型(OR=9.356)是糖尿病患者骨科手术后感染的危险因素(P＜0.05)；感染患者送检标本共培养分离病原菌31株，其中革兰阳性菌21株占67.74%，革兰阴性菌9株占29.03%，以金黄色葡萄球菌、表皮葡萄球菌为主。
    结论 糖尿病患者骨科手术后感染率高，其危险因素包括糖化血红蛋白和切口类型，且病原菌以金黄色葡萄球菌和表皮葡萄球菌为主。

     

    Abstract:
    OBJECTIVE To investigate the pathogenic bacteria causing postoperative infection in patients with diabetes undergoing orthopedic surgery and analyze the risk factors for such postoperative infections.
    METHODS A total of 140 patients with diabetes who underwent orthopedic surgery at the Second Affiliated Hospital of Guangxi Medical University from Jan. 2023 to Dec. 2024 were selected. Based on postoperative infection status, they were divided into an infection group (n=24) and a non-infection group (n=116). The two groups were compared in terms of gender, age, body mass index, blood glucose levels, operation time, surgical approach, incision length and other indicators. Logistic regression analysis was performed to explore the risk factors for postoperative infection in patients with diabetes undergoing orthopedic surgery. Additionally, the infected strains and levels of inflammatory factors interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were measured.
    RESULTS Among the 140 patients, 24 cases developed postoperative infections, with an incidence rate of 17.14% (24/140). The majority of infections occurred at the incision site (45.83%). The levels of IL-6, TNF-α and CRP in the infection group were (2.71±0.43) ng/ml, (9.71±1.58) ng/ml and (11.62±1.35) mg/L, respectively, significantly higher than those in the non-infection group (P < 0.05). HbA1c level (OR=5.987) and incision type (OR=9.356) were identified as risk factors for postoperative infection in patients with diabetes undergoing orthopedic surgery (P < 0.05). A total of 31 pathogenic bacteria were isolated from specimens of infected patients, including 21 gram-positive bacteria (67.74%) and 9 gram-negative bacteria (29.03%), with Staphylococcus aureus and Staphylococcus epidermidis being the main pathogenic bacteria.
    CONCLUSIONS The postoperative infection rate is high among patients with diabetes undergoing orthopedic surgery. Risk factors include HbA1c level and incision type, with Staphylococcus aureus and Staphylococcus epidermidis being the main pathogenic bacteria.

     

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