Analysis And Prevention Of Hospital Acquired Infections And Multidrug-resistant Organisms Infection In Elderly Postoperative Patients With Hip Fracture

Objective:To provide reference for the prevention and control of hospital acquired infections and multidrug-resistant organisms infection in elderly postoperative patients with hip fracture,by retrospectively analyzing the data of hospital acquired infections and multidrug-resistant organisms in elderly postoperative patients with hip fracture,obtaining the incidence and risk factors of hospital acquired infection and multidrug-resistant organisms infection,exploring the distribution and characteristics of bacteria,and analyzing the risk factors of infection.Methods:According to the screening conditions,basic data of patients over 60 years old who underwent surgical treatment for peri-hip fractures in a third-class hospital in Zibo city from January 2013 to April 2019 were collected.Patients were divided into hospital acquired infection group(HAI+ group)and non-hospital acquired infection group(HAIgroup)according to whether or not hospital acquired infection occurred.Statistical analysis was performed in the two groups to preliminarily screen the risk factors of acquired infection in the hospital,and the possible risk factors were analyzed by multivariate non-conditional logistic regression analysis.Patients were divided into the MDRO+ group and the MDRO-group according to the occurrence of MDRO.Statistical analysis was performed in the two groups to preliminarily screen the risk factors of acquired infection in the hospital,and the possible risk factors were analyzed by multivariate nonconditional logistic regression analysis.Result:1.A total of 1,160 elderly patients with peri-hip fractures were eligible for screening,including 98 patients with hospital-acquired infection(HAI+ group),with an incidence of8.45%,and 1062 patients without hospital-acquired infection(HAI-group).A total of116 positive samples were collected,and 186 strains of 38 species of pathogenic bacteria were detected,including 119 strains of 24 species of gram-negative bacteria,accounting for 63.98%;55 strains of 10 species of gram-positive bacteria,accounting for29.57%;12 strains of 4 species of fungus and,accounting for 6.45%.Of the 116 specimens,there were 65(56.03%)respiratory tract specimens,27(23.28%)urinary tract specimens,21(18.10%)incision secretions,and 3(2.59%)blood specimens.There is a close relation between nosocomial infection and patients older than 75 years old,bed time for more than 1 week,preoperative days for more than 3 days,complications of internal chronic disease,perioperative treatment in the ICU,perioperative for endotracheal intubation,postoperative hypoalbuminemia,etc..multivariate non-conditional logistic regression analysis suggests seven risk factors were independent risk factors of hospital acquired infections.2.Multidrug-resistant bacterial infection(MDRO+ group)occurred in 41 patients,with an incidence of 3.53%,while non-multidrug-resistant bacterial infection(MDROgroup)occurred in 1119 patients.A total of 42 positive samples were collected and 43 strains of multi-drug resistant bacteria were detected.18 strains of mrsa(41.86%),14 strains of acinetobacter baumannii(32.56%),5 strains of enterobacteriaceae(11.63%),4strains of pseudomonas aeruginosa(9.30%),and 2 strains of enterococcus vancomycin-resistant(4.65%)were obtained.Among the cases of multi-drug resistant bacteria infection,25 samples of respiratory tract infection(59.52%),10 samples of urinary tract infection(23.81%),6 samples of surgical incision infection(14.29%),and 1sample of blood infection(2.38%)were found.Two pathogenic bacteria were cultured in one patient with respiratory tract infection and,and the other with both respiratory tract infection and urinary tract infection.Independent risk factors for hospital-acquired infection are patient more than 75 years old,bed time for more than 1 week,preoperative days for more than 3 days,complications of internal chronic disease,perioperative treatment in the ICU,perioperative for endotracheal intubation,postoperative hypoalbuminemia,etc..Five risk factors other than age and complications of internal disease were independent risk factors for multidrug-resistant bacterial infections.Conclusion:In the elderly patients with hip fracture,respiratory tract and urinary tract were the main acquired infections,and gram-negative bacilli were the most common bacteria.More than 2/5 of the patients with nosocomial infections were infected by multi-drug resistant bacteria,with respiratory and urinary tract infections being the most common.Methicillin-resistant staphylococcus aureus and carbapene-resistant acinetobacter baumannii are the most common pathogens.Independent risk factors for hospital-acquiredinfection are patient more than 75 years old,bed time for more than 1 week,preoperative days for more than 3 days,complications of internal chronic disease,perioperative treatment in the ICU,perioperative for endotracheal intubation,postoperative hypoalbuminemia,etc..Five risk factors other than age and complications of internal disease were independent risk factors for multidrug-resistant bacterial infections.It is necessary to pay more attention to the risk factors and give higher prevention awareness to the elderly patients with hip fracture.