Infection After Fracture: An Investigation And Analysis Of Multi-Drug Resistant

Objective: With the rapid development of the economy and transport ,variety of opened injuries also increased year by year. For the variety of open injury, an important way to prevent infection is antibiotics. With the antibiotics, particularly broad-spectrum antibiotic using increase, the emergence of resistant strains is also increasing. The blind application of antibiotics has accelerated the production of resistant strains. How rational use of antibiotics, slowing the generation of resistant strains become the problem that clinicians urgently need to Solution. In this study, we chose the patients who was infected by the bacterial, and collected specimens. The specimens were given the germiculture and antibiotic susceptibility test. And we analyzed of the pathogen that cause wound infections and drug resistance characteristics. We hope our conclusion that can be useful for clinical work.Methods:1 Case collection We selected 51 patients who were infected after treated in our hospital emergency room and orthopedic wards during 2010-01 ~ 2011-01 . 41 males and 10 females. traffic accident 24 cases, mechanical strangulation injuries 12 cases, injured by a crashing object 6, injury by falling 4 cases, fall 3 cases , the other 2 patients, aged 4 to 56 years old, and average of 35.44 years old; Closed wound infection occurred in 5 cases, 46 cases of open injury. Preoperative and postoperative infections, 86 specimens were sent to culture, including 63 strains of bacteria cultured, 23 were not cultured bacteria or cultured normal bacterial.2 Specimen collection For open fractures, we collected secretions before debridement, and collected amount of deep pollution tissue as samples when debridement, and two of this as a specimen for inspection. For the postoperative infection of open fractures and closed fractures, we collected secretions in different parts at different depths.For the closed wound infection , pus and secretion samples were collected and submited for censorship. Specimens collection was in strict accordance with the principles of sterile, exclude the possibility of contamination.3 Germiculture Bacteria cultured in the hospital laboratory, Susceptibility testing used disc diffusion method (K-B method), the results for judging reference to NCCL S 1999 edition of the standard interpretation; with the standard strains of Staphylococcus aureus A TCC 25923, Escherichia coli A TCC 25922, Pseudomonas aeruginosa A TCC 27853 for internal qualitycontrol. Result: Form the 51 patients, 86 samples were collected, of which 63 strains of pathogenic bacteria were detected, 23 were not detected or detected normal flora bacteria, 73.26% detection rate of pathogenic bacteria; gram-positive bacteria accounted for 19.0%, gram-negative bacteria accounted for 81%. Detected 30 strains of multi-drug resistant, accounting for 47.6% of all pathogens, including 15 strains of Acinetobacter baumannii, Staphylococcus aureus 7 strains, 4 strains of Pseudomonas aeruginosa, Escherichia coli 4. Acinetobacter baumannii was the major resistant strains, and all were pan-resistant strains; Staphylococcus aureus, including meticillin resistant S. au reus (MRSA ) strain 3, accounting for 42.8% of resistant bacteria, vancomycin resistant strains was not found ; most of Escherichia coli was producing extended spectrum mainlyβ-lactamases (ESBLs (+)) strains, resistant to third generation cephalosporins rate was >50%, resistance rates to quinolones was <50%, resistance rates to imipenem was 0; Most of Pseudomonas aeruginosa was non-resistant strains, and were sensitive to the general antibiotics against gram-negative bacteria, not found resistance to carbapenem; Enterobacter cloacae did not found that resistant strains, and can give most of the antibiotics; The remaining pathogenic bacteria were not common bacteria, and were non-resistant bacteria. And these bacteria should be cultured and given treatment based on susceptibility, Prevent and mitigate the emergence of less common pathogens's resistant strains. Conclusion: The drug-resistant of orthopedic ward mainly was nosocomial infections, Acinetobacter baumannii was the major, and generally was pan-resistant bacteria, and this does not match to other reports;The using of antibiotics should be based on susceptibility, and restrict the use of certain antibiotics, and slow down the emergence of resistant bacteria.