腹部手术切口感染的病原菌分布及影响因素  

Distribution and influencing factors of pathogenic bacteria in abdominal surgical incision infection

作　　者：陈应驹 廖伟明 磨鹏诗 梁永辉 刘达 CHEN Ying-ju;LIAO Wei-ming;MO Peng-shi;LIANG Yong-hui;LIU Da(Department of General Surgery,Shunde Hospital Affiliated to Guangzhou Medical University,Foshan,Guangdong 528315,China)

机构地区：[1]广州医科大学附属顺德医院普外科,广东佛山528315

出　　处：《热带医学杂志》2019年第10期1279-1281,1296,共4页Journal of Tropical Medicine

摘　　要：目的分析腹部手术切口感染的病原菌分布情况和相关影响因素。方法回顾性分析2015年1月至2018年12月广州医科大学附属顺德医院726例腹部手术患者的临床资料,将发生术后切口感染的42例患者纳入感染组,余684例患者纳入未感染组。观察感染组患者病原学分布特点,分析影响腹部手术患者手术切口感染的危险因素。结果726例腹部手术患者术后发生切口感染者42例(5.79%)。感染患者切口分离出病原菌52株,其中革兰阴性杆菌34株(65.38%),革兰阳性菌16株(30.77%),真菌2株(3.85%)。感染组年龄≥60岁、合并糖尿病、急诊手术、手术切口Ⅱ和Ⅲ型、手术时间≥2 h、围术期未使用抗生素及住院时间≥7 d患者所占比例分别为61.90%、38.10%、28.57%、61.91%、30.95%、61.90%、57.14%、64.29%,较未感染组的33.92%、18.13%、14.91%、56.43%、8.92%、37.28%、33.92%、44.88%高,差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄≥60岁、合并糖尿病、手术切口Ⅱ和Ⅲ型、手术时间≥2 h是影响腹部手术患者术后切口感染的独立危险因素,围术期使用抗生素为其保护因素,差异均有统计学意义(P<0.05)。结论腹部手术切口感染病原菌以大肠埃希菌为代表的革兰阴性菌为主,年龄≥60岁、合并糖尿病、手术切口Ⅱ和Ⅲ型、手术时间≥2 h是影响其发生的独立危险因素,应予以重视。Objective To analyze the distribution and related influencing factors of pathogenic bacteria in abdominal surgical incision infection.Methods The clinical data of 726 patients with abdominal surgery in Shunde Hospital Affiliated to Guangzhou Medical University from January 2015 to December 2018 were retrospectively analyzed.42 patients with postoperative incision infection were included in infection group,and the remaining 684 patients were included in non-infection group.The pathogenic distribution characteristics were observed in infection group,and the risk factors affecting the surgical incision infection of patients with abdominal surgery were analyzed.Results Among the 726 patients with abdominal surgery,42 cases(5.79%)had incision infection.52 strains of pathogenic bacteria were isolated from infected patients,including 34 strains of Gram-negative bacilli(65.38%),16 strains of Gram-positive bacteria(30.77%)and 2 strains of fungi(3.85%).The proportion of age≥60 years old,diabetes mellitus,emergency surgery,surgical incision typesⅡandⅢ,operative time≥2 h,perioperative non-use of antibiotics and hospital stay≥7 d in infection group(61.90%,38.10%,28.57%,61.91%,30.95%,61.90%,57.14%,64.29%)were higher than those in non-infection group(33.92%,18.13%,14.91%,56.43%,8.92%,37.28%,33.92%,44.88%)(P<0.05).Logistic regression analysis showed that age≥60 years old,diabetes mellitus,surgical incision typesⅡandⅢand operative time≥2 h were independent risk factors for postoperative incision infection in patients undergoing abdominal surgery,and perioperative use of antibiotics was a protective factor(P<0.05).Conclusions The pathogenic bacteria of abdominal surgical incision infection were mainly Gram-negative bacteria represented by Escherichia coli.Age≥60 years old,diabetes mellitus,surgical incision typesⅡandⅢand operative time≥2 h were independent risk factors affecting the occurrence,and attention should be paid.

关 键 词：腹部 手术切口 感染 病原学分布 影响因素 

分 类 号：R656[医药卫生—外科学]