Risk factors for multidrug-resistant bacteria recurrent infections in orthopedic patients from 2011 to 2017 / 中华创伤骨科杂志

ABSTRACT

Objective To explore the clinical characteristics of multidrug-resistant organisms (MDROS) and analyze the risk factors for MDROS recurrent infections in orthopedic in-patients.Methods A retrospective study was conducted of the clinical data of 296 in-patients with MDROS infection from June 2011 to August 2017.They were 216 males and 80 females with an average age of 49.9 years.Their average hospital stay was 37.2 days.Univariate analysis was conducted for items like age,hospital stay,bedridden time,concomitant internal disease (chronic obstructive pulmonary disease,chronic cardiovascular disease and diabetes),open or closed fracture,uninary catheter,use of hormone,stay in ICU,implantation material,incision grade,albumin level,hemoglobin level,reoperation,type of antibiotics and duration of antibiotics use.Multivariate logistic regression analysis was performed using SPSS 20.0 for items with significant differences.Results A total of 352 strains of pathogens were isolated,including methicillin-resistant staphylococcus aureus (26.7％),extended-spectrum β-lactamase-producing Escherichia coli (24.4％) and multidrug-resistant acinetobacter baumannii (24.1％).The pathogens were observed mostly at surgical sites (34.1％) and open wounds (23.0％).Forty-two patients reinfected the same strain after treatment.The multivariate logistic regression analysis revealed the following as the independent risk factors for MDROS recurrent infections in the orthopedic in-patientshospital stay [OR =4.918,95％ CI (1.642,14.731),P =0.004],long bedridden time [OR=3.583,95％ CI (1.081,11.876),P=0.037],open injury [OR=2.375,95％CI (1.291,4.368),P=0.005],diabetes [OR=6.360,95％ CI (2.112,19.149),P=0.001],and chronic obstructive pulmonary disease [OR=4.170,95％ CI (1.419,12.251),P=0.009].Conclusions To prevent recurrent MDROS infections in orthopedic patients,surgeons should shorten unnecessary hospital stay,encourage ambulation as early as possible,effectively control blood sugar and actively treat concomitant internal diseases in addition to regular use of antibiotics.