Clinical characteristics and risk factors of blood stream infections after orthopedic surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Yilun ¹ , LIU Zeshi ² , YANG Pei ¹ , SONG Jinhui ¹ , CHEN Yuanyuan ¹ , ZHANG Yanping ² ,  WANG Kunzheng ¹

1. Department of Orthopedic and Joint Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004, P.R.China;
2. Department of Hematology, the Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an Shaanxi, 710004, P.R.China;

Corresponding?author：

WANG Kunzheng, Email: wkzh1955@163.com

Keywords：

Orthopedics; blood stream infection; pathogenic bacteria; complication; risk factor

DOI：

10.7507/1002-1892.202010090

Video：

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Objective To analyze the clinical characteristics, risk factors, and drug resistance of pathogenic bacteria in patients with blood stream infections (BSI) after orthopedic surgery, so as to provide reference and basis for clinical diagnosis and treatment.Methods A retrospective analysis was made on the clinical data of 6 348 orthopedic patients admitted for surgery between January 2017 and December 2019. There were 3 598 males and 2 750 females. Their age ranged from 18 to 98 years, with an average of 66 years. The data of patients were collected, and the risk factors of BSI were analyzed by univariate analysis and logistic regression analysis. The distribution of BSI pathogenic bacteria, the results of drug sensitivity test, the incidence of BSI in patients after orthopedic surgery in different years, and the common sites of BSI secondary infection were summarized.Results BSI occurred in 106 (1.67%) of 6 348 patients after orthopedic surgery. There were 71 cases (66.98%) of secondary infection. The mortality of postoperative BSI patients was 1.89%, and the difference was significant when compared with that of non-postoperative BSI patients (0.24%) (χ²=5.313, P=0.021). The incidences of BSI in 2017, 2018, and 2019 were 1.18%, 1.53%, and 2.17%, respectively, showing an increasing trend year by year (trend χ²=6.610, P=0.037). Statistical analysis showed that the independent risk factors for BSI after orthopedic surgery (P<0.05) included the trauma, length of hospital stay≥14 days, emergency surgery, postoperative leukocyte counting<4×10⁹/L, level of hemoglobin≤90 g/L, albumin≤30 g/L, the time of indwelling ureter>24 hours, use of deep vein catheter insertion, and merging other site infection. Blood culture showed 56 strains (52.83%) of Gram-positive bacteria, 47 strains (44.34%) of Gram-negative bacteria, and 3 strains (2.83%) of fungi. The top three pathogenic bacteria were coagulase negative Staphylococci (CNS; 36 strains, 33.96%), Escherichia coli (16 strains, 15.09%), and Staphylococcus aureus (15 strains, 14.15%). The detection rates of extended-spectum β-lactamases producing strains of Escherichia coli and Klebsiella pneumoniae were 56.25% (9/16) and 44.44% (4/9), respectively. The detection rates of methicillin-resistant strains in Staphylococcus aureus and CNS were 46.67% (7/15) and 72.22% (26/36), respectively.Conclusion Postoperative BSI in orthopedic patients is caused by multiple factors. Preventive measures should be taken according to related risk factors and perioperative risk assessment should be strengthened. Staphylococcus and Escherichia coli are the most common pathogenic bacteria in BSI after orthopedic surgery. The infection rate and drug-resistant bacteria are increasing year by year. Therefore, drug resistance monitoring should be strengthened.

Citation： TANG Yilun, LIU Zeshi, YANG Pei, SONG Jinhui, CHEN Yuanyuan, ZHANG Yanping, WANG Kunzheng. Clinical characteristics and risk factors of blood stream infections after orthopedic surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(5): 593-600. doi: 10.7507/1002-1892.202010090 Copy

1.	王艷, 邸師紅, 吳俊, 等. 骨科患者血流感染的臨床特點及病原學分析. 中國感染與化療雜志, 2019, 19(3): 263-268.
2.	杜娟, 魯維麗, 朱曉瓊. 骨科住院手術患者醫院感染及引起感染影響因素回顧性調查. 中華醫院感染學雜志, 2018, 28(21): 3286-3288, 3292.
3.	周庭銀, 倪語星, 王明貴, 等. 血流感染實驗診斷與臨床診治. 2版. 上海: 上海科學技術出版社, 2014: 3-6.
4.	中華人民共和國國家衛生和計劃生育委員會. 臨床微生物實驗室血培養操作規范(WS/T 503-2017)[S/OL]. (2017-09-06) [2018-09-01]. http://www.nhc.gov.cn/wjw/s9492/201710/f5612af688db482193a08b15e3091a29.shtml.
5.	中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
6.	馬序竹, 鄭波, 李湘燕, 等. 成人血流感染的臨床特點及病原學分析. 中華醫院感染學雜志, 2017, 27(17): 3860-3863.
7.	Michal W, Kryspin N, Maciej R, et al. Arthroscopic-assisted arthrodesis of the knee joint with the Ilizarov technique: A case report and literature review. Medicine (Baltimore), 2016, 95(3): e2540. doi: 10.1097/MD.0000000000002540.
8.	白景棠, 高艷霞, 李澤清, 等. 骨科手術后感染發生率及原因分析. 現代儀器與醫療, 2019, 25(1): 62-65.
9.	李娜, 余劍華, 胡昌妹, 等. ICU血流感染病原菌特征及混合血流感染的危險因素分析. 中外醫療, 2016, 35(27): 110-112.
10.	張曉芳, 劉方竹, 劉明建. 血流感染的危險因素分析及其與早期炎癥因子相關性研究. 中國現代醫學雜志, 2015, 25(11): 51-54.
11.	申鳳彩, 解迪, 韓錢鵬, 等. ICU血流感染病原菌特征及混合血流感染的危險因素分析. 中華危重病急救醫學, 2015, (9): 718-723.
12.	Shallwani H, Shakir HJ, Aldridge AM, et al. Mandatory change from surgical skull caps to bouffant caps among operating room personnel does not reduce surgical site infections in class Ⅰ surgical cases: A single-center experience with more than 15 000 patients. Neurosurgery, 2018, 82(4): 548-554.
13.	湯海波, 胡小平. 多發性創傷患者醫院感染病原學及危險因素分析. 中外醫學研究, 2020, 18(11): 134-136.
14.	元智昊, 閆紅, 李玉堂, 等. 多發傷患者免疫功能抑制相關機制的研究. 解放軍醫學院學報, 2016, 37(8): 842-844.
15.	張榮, 劉詠芳, 湯魯明, 等. 多發傷合并肺部感染患者血清及痰液細胞因子的變化觀察. 中華醫院感染學雜志, 2017, 27(2): 348-350.
16.	李鵬飛. 創傷血流感染患者預后影響因素的研究. 重慶: 重慶醫科大學, 2020.
17.	Prevaldi C, Paolillo C, Locatelli C, et al. Management of traumatic wounds in the Emergency Department: position paper from the Academy of Emergency Medicine and Care (AcEMC) and the World Society of Emergency Surgery (WSES). World J Emerg Surg, 2016, 11: 30.
18.	Kazaure HS, Martin M, Yoon JK, et al. Long-term results of a postoperative pneumonia prevention program for the inpatient surgical ward. JAMA Surg, 2014, 149(9): 914-918.
19.	Bohl DD, Shen MR, Kayupov E, et al. Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty. J Arthroplasty, 2016, 31(1): 15-21.
20.	張之南, 單淵東. 協和血液病學. 北京: 中國協和醫科大學出版社, 2004.
21.	龔健, 賀安勇, 方楊, 等. 重癥感染合并血小板減少癥的危險因素分析. 海南醫學, 2017, 28(10): 1681 -1683.
22.	寧寧, 呂娟, 何凌霄, 等. 骨科急性創面感染的危險因素分析. 中國修復重外科雜志, 2014, 28(6): 714-717.
23.	Jeddi R, Ghédira H, Ben Amor R, et al. Risk factors of septic shock in patients with hematologic malignancies and Pseudomonas infections. Hematology, 2011, 16(3): 160-165.
24.	陶然. 成人血流感染的回顧性臨床研究. 上海: 上海交通大學, 2017.
25.	劉亞波, 白濤, 龐軍, 等. 骨科手術患者切口感染發生情況及影響因素回顧性分析. 解放軍預防醫學雜志, 2017, 35(7): 762-764.
26.	王斌. 創傷骨科術后感染的流行病學調查及相關因素分析—以甘肅省骨傷科臨床醫學中心為例. 蘭州: 甘肅中醫藥大學, 2020.
27.	吳嫻波. 醫院感染流行病學研究. 廣州: 第一軍醫大學, 2007.
28.	Nkwouano V, Witkowski S, Rehberg N, et al. A novel mycobacterial in vitro infection assay identifies differences of induced macrophage apoptosis between CD4+ and CD8+ T cells. PLoS One, 2017, 12(2): e0171817. doi: 10.1371/journal.pone.0171817.
29.	宋曉超, 趙麗娜, 喬美珍, 等. 神經外科Ⅰ類切口手術部位感染的影響因素分析. 中華醫院感染學雜志, 2019, 29(12): 1838-1841, 1866.
30.	Sneh-Arbib O, Shiferstein A, Dagan N, et al. Surgical site infections following craniotomy focusing on possible post-operative acquisition of infection: prospective cohort study. Eur J Clin Microbiol Infect Dis, 2013, 32(12): 1511-1516.
31.	Iwuafor AA, Ogunsola FT, Oladele RO, et al. Incidence, clinical outcome and risk factors of intensive care unit infections in the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. PLoS ONE, 2016, 11(10): e0165242. doi: 10.1371/journal.pone.0165242.
32.	Kang CI, Chung DR, Son JS, et al. Clinical significance of nosocomial acquisition in urinary tract-related bacteremia caused by gram-negative bacilli. Am J Infect Control, 2011, 39(2): 135-140.
33.	余一海, 陳柳勤, 彭惠詩, 等. 陽性時間差、導管半定量和定量培養在診斷中心靜脈導管相關性血流感染中的應用比較. 廣東醫學, 2013, 34(15): 2352-2354.
34.	張京利, 王力紅, 馬文暉, 等. 中心靜脈導管相關血流感染的診治及預防. 中華醫院感染學雜志, 2008, 18(7): 952-954.
35.	查翔遠, 潘曉龍, 胡志軍, 等. 2010-2014年血培養分離菌的分布及耐藥性分析. 中國感染與化療雜志, 2016, 16(5): 602-607.
36.	趙建萍, 李國雄. 骨科感染標本的病原學分析. 中國衛生檢驗雜志, 2010, 20(1): 135-137.
37.	胡付品, 郭燕, 朱德妹, 等. 2017年CHINET中國細菌耐藥性監測. 中國感染與化療雜志, 2018, 18(3): 241-251.
38.	胡付品, 郭燕, 朱德妹, 等. 2019年CHINET三級醫院細菌耐藥監測結果. 中國感染與化療雜志, 2020, 20(3): 233-243.
39.	姜可偉, 呂游, 郭鵬, 等. 外科感染患者細菌分布及耐藥性的單中心研究. 中華外科雜志, 2013, 51(7): 604-609.
40.	Pongrácz J, Kristóf K. Candida bloodstream infection: a clinical microbiology laboratory perspective. Acta Microbiol Immunol Hung, 2014, 61(3): 389-398.

1. 王艷, 邸師紅, 吳俊, 等. 骨科患者血流感染的臨床特點及病原學分析. 中國感染與化療雜志, 2019, 19(3): 263-268.
2. 杜娟, 魯維麗, 朱曉瓊. 骨科住院手術患者醫院感染及引起感染影響因素回顧性調查. 中華醫院感染學雜志, 2018, 28(21): 3286-3288, 3292.
3. 周庭銀, 倪語星, 王明貴, 等. 血流感染實驗診斷與臨床診治. 2版. 上海: 上海科學技術出版社, 2014: 3-6.
4. 中華人民共和國國家衛生和計劃生育委員會. 臨床微生物實驗室血培養操作規范(WS/T 503-2017)[S/OL]. (2017-09-06) [2018-09-01]. http://www.nhc.gov.cn/wjw/s9492/201710/f5612af688db482193a08b15e3091a29.shtml.
5. 中華人民共和國衛生部. 醫院感染診斷標準(試行). 中華醫學雜志, 2001, 81(5): 314-320.
6. 馬序竹, 鄭波, 李湘燕, 等. 成人血流感染的臨床特點及病原學分析. 中華醫院感染學雜志, 2017, 27(17): 3860-3863.
7. Michal W, Kryspin N, Maciej R, et al. Arthroscopic-assisted arthrodesis of the knee joint with the Ilizarov technique: A case report and literature review. Medicine (Baltimore), 2016, 95(3): e2540. doi: 10.1097/MD.0000000000002540.
8. 白景棠, 高艷霞, 李澤清, 等. 骨科手術后感染發生率及原因分析. 現代儀器與醫療, 2019, 25(1): 62-65.
9. 李娜, 余劍華, 胡昌妹, 等. ICU血流感染病原菌特征及混合血流感染的危險因素分析. 中外醫療, 2016, 35(27): 110-112.
10. 張曉芳, 劉方竹, 劉明建. 血流感染的危險因素分析及其與早期炎癥因子相關性研究. 中國現代醫學雜志, 2015, 25(11): 51-54.
11. 申鳳彩, 解迪, 韓錢鵬, 等. ICU血流感染病原菌特征及混合血流感染的危險因素分析. 中華危重病急救醫學, 2015, (9): 718-723.
12. Shallwani H, Shakir HJ, Aldridge AM, et al. Mandatory change from surgical skull caps to bouffant caps among operating room personnel does not reduce surgical site infections in class Ⅰ surgical cases: A single-center experience with more than 15 000 patients. Neurosurgery, 2018, 82(4): 548-554.
13. 湯海波, 胡小平. 多發性創傷患者醫院感染病原學及危險因素分析. 中外醫學研究, 2020, 18(11): 134-136.
14. 元智昊, 閆紅, 李玉堂, 等. 多發傷患者免疫功能抑制相關機制的研究. 解放軍醫學院學報, 2016, 37(8): 842-844.
15. 張榮, 劉詠芳, 湯魯明, 等. 多發傷合并肺部感染患者血清及痰液細胞因子的變化觀察. 中華醫院感染學雜志, 2017, 27(2): 348-350.
16. 李鵬飛. 創傷血流感染患者預后影響因素的研究. 重慶: 重慶醫科大學, 2020.
17. Prevaldi C, Paolillo C, Locatelli C, et al. Management of traumatic wounds in the Emergency Department: position paper from the Academy of Emergency Medicine and Care (AcEMC) and the World Society of Emergency Surgery (WSES). World J Emerg Surg, 2016, 11: 30.
18. Kazaure HS, Martin M, Yoon JK, et al. Long-term results of a postoperative pneumonia prevention program for the inpatient surgical ward. JAMA Surg, 2014, 149(9): 914-918.
19. Bohl DD, Shen MR, Kayupov E, et al. Hypoalbuminemia independently predicts surgical site infection, pneumonia, length of stay, and readmission after total joint arthroplasty. J Arthroplasty, 2016, 31(1): 15-21.
20. 張之南, 單淵東. 協和血液病學. 北京: 中國協和醫科大學出版社, 2004.
21. 龔健, 賀安勇, 方楊, 等. 重癥感染合并血小板減少癥的危險因素分析. 海南醫學, 2017, 28(10): 1681 -1683.
22. 寧寧, 呂娟, 何凌霄, 等. 骨科急性創面感染的危險因素分析. 中國修復重外科雜志, 2014, 28(6): 714-717.
23. Jeddi R, Ghédira H, Ben Amor R, et al. Risk factors of septic shock in patients with hematologic malignancies and Pseudomonas infections. Hematology, 2011, 16(3): 160-165.
24. 陶然. 成人血流感染的回顧性臨床研究. 上海: 上海交通大學, 2017.
25. 劉亞波, 白濤, 龐軍, 等. 骨科手術患者切口感染發生情況及影響因素回顧性分析. 解放軍預防醫學雜志, 2017, 35(7): 762-764.
26. 王斌. 創傷骨科術后感染的流行病學調查及相關因素分析—以甘肅省骨傷科臨床醫學中心為例. 蘭州: 甘肅中醫藥大學, 2020.
27. 吳嫻波. 醫院感染流行病學研究. 廣州: 第一軍醫大學, 2007.
28. Nkwouano V, Witkowski S, Rehberg N, et al. A novel mycobacterial in vitro infection assay identifies differences of induced macrophage apoptosis between CD4+ and CD8+ T cells. PLoS One, 2017, 12(2): e0171817. doi: 10.1371/journal.pone.0171817.
29. 宋曉超, 趙麗娜, 喬美珍, 等. 神經外科Ⅰ類切口手術部位感染的影響因素分析. 中華醫院感染學雜志, 2019, 29(12): 1838-1841, 1866.
30. Sneh-Arbib O, Shiferstein A, Dagan N, et al. Surgical site infections following craniotomy focusing on possible post-operative acquisition of infection: prospective cohort study. Eur J Clin Microbiol Infect Dis, 2013, 32(12): 1511-1516.
31. Iwuafor AA, Ogunsola FT, Oladele RO, et al. Incidence, clinical outcome and risk factors of intensive care unit infections in the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. PLoS ONE, 2016, 11(10): e0165242. doi: 10.1371/journal.pone.0165242.
32. Kang CI, Chung DR, Son JS, et al. Clinical significance of nosocomial acquisition in urinary tract-related bacteremia caused by gram-negative bacilli. Am J Infect Control, 2011, 39(2): 135-140.
33. 余一海, 陳柳勤, 彭惠詩, 等. 陽性時間差、導管半定量和定量培養在診斷中心靜脈導管相關性血流感染中的應用比較. 廣東醫學, 2013, 34(15): 2352-2354.
34. 張京利, 王力紅, 馬文暉, 等. 中心靜脈導管相關血流感染的診治及預防. 中華醫院感染學雜志, 2008, 18(7): 952-954.
35. 查翔遠, 潘曉龍, 胡志軍, 等. 2010-2014年血培養分離菌的分布及耐藥性分析. 中國感染與化療雜志, 2016, 16(5): 602-607.
36. 趙建萍, 李國雄. 骨科感染標本的病原學分析. 中國衛生檢驗雜志, 2010, 20(1): 135-137.
37. 胡付品, 郭燕, 朱德妹, 等. 2017年CHINET中國細菌耐藥性監測. 中國感染與化療雜志, 2018, 18(3): 241-251.
38. 胡付品, 郭燕, 朱德妹, 等. 2019年CHINET三級醫院細菌耐藥監測結果. 中國感染與化療雜志, 2020, 20(3): 233-243.
39. 姜可偉, 呂游, 郭鵬, 等. 外科感染患者細菌分布及耐藥性的單中心研究. 中華外科雜志, 2013, 51(7): 604-609.
40. Pongrácz J, Kristóf K. Candida bloodstream infection: a clinical microbiology laboratory perspective. Acta Microbiol Immunol Hung, 2014, 61(3): 389-398.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical characteristics and risk factors of blood stream infections after orthopedic surgery

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