| Objective:To study the distribution characteristics of pathogenic bacteria in post-traumatic osteomyelitis(PTO)and the drug resistance of major pathogens,and to explore the diagnostic value of erythrocyte sedimentation rate(ESR)and neutrophil/lymphocyte ratio(NLR)in PTO.Methods:A total of 47 patients from the Department of Orthopedics,Affiliated Hospital of North Sichuan Medical College,from March 2020 to September 2021,who came to seek medical advice due to trauma or post-operative infection and were diagnosed with PTO of the extremities were selected and included in the observation group,including 35 males and 12 females;aged 15-68 years old,with an average age of 48.17 years old;20 cases were located in the tibia,12 cases in the femur,and 15 cases in other parts(including the humerus,ulna and radius,patella,calcaneus,etc.);A total of 40 patients with extremity fractures who received treatment during the same period but did not develop osteomyelitis were selected and included in the control group,including 30 males and 10 females;aged 6-77 years,with an average age of 43.98 years;17 cases were located in the tibia and 8 cases were in the femur.15 cases of other parts(including humerus,ulna and radius,patella,calcaneus,etc.);Then a total of 40 healthy subjects were selected and included in the blank control group,including 29 males and 11 females,aged 20-60 years,with an average age of 43 years.The pathogenic bacteria culture results and drug susceptibility results of the observation group were collected,and the results of peripheral venous erythrocyte sedimentation rate and neutrophil/lymphocyte ratio in the early morning of the next day after admission in the observation group,control group and blank control group were collected.The distribution characteristics of pathogenic bacteria and the drug resistance of main pathogens in the observation group were analyzed;the levels of ESR and NLR in the three groups were compared,and the Receiver operation characteristic curve(ROC)was used to evaluate the diagnostic value of the two for PTO.Results:Among the 47 cases in the observation group,33 cases were cultured with pathogenic bacteria,with a positive rate of 70.21%,of which 11 cases were mixed infections,accounting for 23.40%.Among the strain-positive patients,there were 26 gram-positive bacteria,accounting for 50.98%,and the highest proportion was Staphylococcus aureus;there were 22 gram-negative bacteria,accounting for 43.14%,and the highest proportion was Pseudomonas aeruginosa;there were 3 fungi,accounting for 5.88%.Staphylococcus aureus cultured in the observation group had higher resistance rates to penicillin(83.33%),erythromycin(75.00%),tetracycline(41.67%),oxacillin(33.33%)and clindamycin(33.33).The resistance rate of Pseudomonas aeruginosa to ampicillin,ampicillin/sulbactam sodium,co-trimoxazole,cefazolin,ceftriaxone,and cefotetan was as high as 100%.The observation group(ESR:38.21±25.8 mm/h,NLR:4.25±2.97)was higher than the control group(ESR:8.93±7.9 mm/h,NLR:2.82±1.92)(P value<0.05)and the blank control group(ESR:6.75±5.06 mm/h,NLR:2.14±1.03)(P value<0.05),and the difference was statistically significant;there was no significant difference between the control group and the blank control group(P value>0.05).The area under the curve(AUC)of ESR and NLR for the diagnosis separately and their combined diagnosis of PTO were 0.872(Cut-off value 15.5,sensitivity 78.7%,specificity 77.5%),0.704(Cut-off value 3.01),respectively,sensitivity 66.0%,specificity 70.0%),0.888(sensitivity 80.9%,specificity 80.0%),the combined diagnostic efficiency of the two is better than NLR independent diagnosis,the difference is statistically significant(P<0.05).Conclusion:There are many kinds of pathogenic bacteria of PTO,the most common is Staphylococcus aureus.ESR combined with NLR has more reference value for the diagnosis of PTO. |
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