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目的 探讨开放性四肢骨折术后感染病原菌分布特点及危险因素.方法 选择浙江省医疗健康集团杭州医院2016年1月至2018年12月收治的开放性四肢骨折患者180例为研究对象,观察患者术后感染情况.采用全自动生物分析仪及细菌鉴定系统分离鉴定病原菌;采用K-B法进行耐药性试验.采用多因素logistic回归分析影响开放性四肢骨折术后感染危险因素.结果 开放性四肢骨折患者180例中,发生术后感染29例,感染率为16.11％.术后感染29例中,分离病原菌34株,其中革兰阳性菌19株,革兰阴性菌13株,真菌2株.金黄色葡萄球菌对青霉素G耐药率较高,耐药率为80.00％.经单因素分析结果显示,两组性别、体质量指数(BMI)、受伤部位、吸烟史、合并高血压和术中出血量差异均无统计学意义(x2=0.252、0.416、0.734、0.856、0.572,均P＞0.05);两组年龄、合并糖尿病、手术时间、住院时间、伤口污染和术后放置引流管时间比较差异均有统计学意义(x2 =21.537、9.664、17.244、15.459、24.327、19.804,均P＜0.05).将上述单因素分析结果显示,年龄＞60岁、合并糖尿病、手术时间＞3h、住院时间＞14 d、伤口污染和术后放置引流管时间＞4d为影响开放性四肢骨折术后感染独立危险因素.结论 开放性四肢骨折术后感染发生率较高,分离病原菌以革兰阳性菌为主;术后感染受多因素影响,为预防术后感染需采取针对性措施,严格按照药敏实验合理应用抗菌药物.“,”Objective To investigate the distribution characteristics and risk factors of infectious pathogens after open limb fracture surgery.Methods From January 2016 to December 2018,180 patients with open limb fracture admitted to Hangzhou Hospital of Zhejiang Medical and Health Group were selected to observe the infection after operation.Pathogens were isolated and identified by automatic biological analyzer and bacterial identification system,and drug resistance test was carried out by K-B method.Multivariate logistic regression analysis was used to analyze the risk factors of infection after open limb fracture surgery.Results Among 180 cases of open limb fracture,29 cases had postoperative infection,the infection rate was 16.11％.Among 29 cases of post-operative infection,34 strains of pathogenic bacteria were isolated,including 19 strains of Gram-positive bacteria,13 strains of Gram-negative bacteria and 2 strains of fungi.The resistance rate of Staphylococcus aureus to penicillin G was high,and the resistance rate was 80.00％.Univariate analysis showed that there were no statistically significant differences in gender,BMI,injury site,smoking history,hypertension and intraoperative bleeding between the two groups (x2 =0.252,0.416,0.734,0.856,0.572,all P ＞ 0.05).There were statistically significant differences in age,diabetes mellitus,operation time,hospitalization time,wound contamination and drainage tube placement time between the two groups (x2 =21.537,9.664,17.244,15.459,24.327,19.804,all P ＜ 0.05).The single factor analysis showed that age ＞ 60 years old,diabetes mellitus,operation time ＞ 3h,hospitalization time ＞ 14d,wound contamination and drainage tube placement time ＞ 4d were independent risk factors for infection after open limb fracture surgery.Conclusion Postoperative infection rate of open limb fracture is high.Gram-positive bacteria are the main pathogenic bacteria.Postoperative infection is affected by many factors.In order to prevent postoperative infection,specific measures should be taken and antibiotics should be used reasonably in strict accordance with drug sensitivity test.