湘南地区跟骨骨髓炎病因与多重耐药菌感染危险因素

Etiology of calcaneal osteomyelitis and risk factors of multidrug-resistant organism infection in southern Hunan

摘要:

目的 了解跟骨骨髓炎的致病原因、病原菌分布及耐药情况。 方法 回顾性分析2017年1月—2020年12月某院跟骨骨髓炎患者的临床资料。 结果 174例跟骨骨髓炎, 其中136例由外伤所致(78.2%), 32例(18.4%)由糖尿病足感染所致。分离致病菌126株, 主要致病菌为革兰阳性菌(70株, 60.3%), 金黄色葡萄菌和肠球菌分别占36.5%(46株)、11.1%(14株); 革兰阴性杆菌中主要为铜绿假单胞菌(19株, 14.3%); 50例跟骨骨髓炎骨组织标本分离出多重耐药菌, 占28.7%。单因素分析结果显示, 身体质量指数(BMI)、年龄、致病原因、病原菌种类、手术次数是跟骨骨髓炎患者多重耐药菌感染的相关因素, 与跟骨骨髓炎患者非多重耐药菌感染比较, 差异均具有统计学意义(均P＜0.05);logistic回归分析结果显示, 年龄＞60岁、糖尿病足合并感染、厌氧菌感染、手术次数＞5次是跟骨骨髓炎患者多重耐药菌感染的独立危险因素。BMI为18.5~24 kg/m²是跟骨骨髓炎患者多重耐药感染的独立保护因素。 结论 跟骨骨髓炎多由跟骨外伤和糖尿病足导致, 致病菌以金黄色葡萄球菌、肠球菌和铜绿假单胞菌为主, 多重耐药菌感染较多, 需要合理使用抗菌药物。

Abstract:

Objective To investigate the etiology, pathogen distribution and antimicrobial resistance of calcaneal osteomyelitis. Methods Clinical data of patients with calcaneal osteomyelitis in a hospital from January 2017 to December 2020 were analyzed retrospectively. Results There were 174 cases of calcaneal osteomyelitis, 136 of which were caused by trauma (78.2%), 32 (18.4%) were caused by diabetic foot infection. 126 strains of pathogenic bacteria were isolated, the main pathogenic bacteria were Gram-positive bacteria (70 strains, 60.3%), Staphylococcus aureus and Enterococcus accounted for 36.5% (46 strains) and 11.1% (14 strains) respectively; Pseudomonas aeruginosa (19 strains, 14.3%) was the main Gram-negative bacillus; multidrug-resistant organisms (MDROs) were isolated from 50 bone tissue specimens of calcaneal osteomyelitis, accounting for 28.7%. Univariate analysis showed that body mass index (BMI), age, cause of disease, types of pathogens and number of operations were relevant factors for MDRO infection in patients with calcaneal osteomyelitis, compared with non-MDRO infection in patients with calcaneal osteomyelitis, differences were all statistically significant (all P < 0.05); logistic regression analysis showed that age >60 years, diabetic foot combined with infection, anaerobic infection and number of operations >5 times were independent risk factors for MDRO infection in patients with calcaneal osteomyelitis. BMI 18.5-24 kg/m² was an independent protective factor for MDRO infection in patients with calcaneal osteomyelitis. Conclusion Calcaneal osteomyelitis is mainly caused by trauma and diabetic foot, the main pathogenic bacteria are Staphylococcus aureus, Enterococcus and Pseudomonas aeruginosa. MDRO infection is common, which need ratio-nal use of antimicrobial agents.