胃肠道手术后发生耐甲氧西林金黄色葡萄球菌肠炎的危险因素分析  

Analysis on risk factors of methicillin-resistant staphylococcus aureus enterocolitis after gastrointestinal surgery

作　　者：王萌[1] 李阳[2] 郑黎明[1] 管文贤[1] Wang Meng;Li Yang;Zheng Liming;Guan Wenxian(Department of General Surgery,Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital,Nanjing 210008,China;Department of Infection Management,Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院普通外科,210008 [2]南京大学医学院附属鼓楼医院感染管理科,210008

出　　处：《中华胃肠外科杂志》2018年第12期1387-1390,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：江苏省卫计委科研课题(Q201509);南京市青年卫生人才项目(QRX17047).

摘　　要：目的探究胃肠道手术后发生耐甲氧西林金黄色葡萄球菌(MRSA)肠炎的危险因素。方法回顾性分析南京大学医学院附属鼓楼医院普通外科2015年3月至2017年3月间,收治的17例胃肠手术后MRSA肠炎病例的临床病理资料。病例纳入标准:(1)年龄18~80岁;(2)有胃肠手术史;(3)胃肠手术后7d内有腹泻症状;(4)腹泻前使用过抗生素;(5)粪便涂片或粪便菌群比检查提示大量革兰阳性球菌;(6)粪便培养提示存在MRSA;(7)应用针对MRSA的抗生素治疗有效。排除标准:(1)粪便艰难梭菌毒素检测阳性;(2)食物中毒导致的中毒性休克综合征。按照患者性别、年龄、住院病区进行1∶2配对,从同病区住院手术病例中筛选出34例非MRSA肠炎患者作为对照组,进行回顾性病例对照研究。两组患者性别、年龄、体质指数资料比较,差异均无统计学意义(均P>0.05),说明两组间具有可比性。应用χ2检验针对原发疾病性质、结直肠手术、急诊手术、使用多种抗生素、术前肠道准备、围手术期激素、术中腹腔化疗、围手术期鼻胃管、糖尿病病史、重症监护室入住病史和既往感染疾病住院这11项因素进行单因素分析,之后再行多因素logistic回归分析。结果17例MRSA肠炎在术后3~5d发病,有4例迅速发生感染性休克。单因素分析显示,手术部位(结直肠手术)(χ^2=4.747,P=0.029)和发生MRSA肠炎前使用两种抗生素(χ^2=3.959,P=0.047)与胃肠道手术后MRSA肠炎有关。多因素logistic回归分析显示,仅结直肠手术是胃肠道手术后MRSA肠炎的独立危险因素(OR=5.526,95%CI:1.350~22.612,P=0.017),而使用两种抗生素则是其保护因素(OR=0.204,95%CI:0.051~0.819,P=0.025)。结论MRSA肠炎起病迅速,感染性休克发生率较高,需引起重视。结直肠手术是发生MRSA肠炎的独立危险因素,而使用两种抗生素则是其保护因素。Objective To investigate the risk factors of methicillin-resistant Staphylococcus aureus (MRSA)enterocolitis after gastrointestinal surgery.Methods Clinical and pathological data of 17 cases with MRSA enteritis after gastrointestinal surgery from March 2015 to March 2017 at Department of General Surgery of Affiliated Drum Tower Hospital were retrospectively analyzed.Inclusion criteria:(1) age of 18 to 80 years;(2)with history of gastrointestinal surgery;(3)diarrhea symptoms within 7days after gastrointestinal surgery;(4)use of antibiotics before diarrhea;(5)fecal smear showing a large number of gram positive cocci;(6)fecal culture suggested the presence of MRSA;(7)application of antibiotic therapy against MRSA was effective.Exclusion criteria:(1)clostridium difficile toxin positive; (2)toxic shock syndrome caused by food poisoning.According to gender,age,and inpatient ward,1:2 pairing was performed,and 34 patients with non-MRSA enteritis from the hospitalized cases in the same ward were selected as the control group for retrospective case-control study.There were no significant differences in the gender,age,and constitution index between two groups (all P>0.05),indicating that the two groups were comparable.The χ^2 test was used to perform univariate analysis on 11 factors, including the nature of the primary disease,colorectal surgery,emergency surgery,use of multiple antibiotics,preoperative bowel preparation,perioperative hormone,intraoperative intraperitoneal chemotherapy,perioperative nasogastric tube,diabetes history,intensive care unit stay,and previous infectious disease hospitalization,and then multivariate logistic regression analysis was performed.Results MRSA enteritis occurred 3 to 5 days after surgery in all the 17 cases,and 4 cases developed septic shock rapidly.Univariate analysis showed that the operation site (colorectal surgery)(χ^2=4.747,P=0.029)and use of two antibiotics before MRSA enteritis (χ^2=3.959,P=0.047)were associated with MRSA enteritis after gastrointestinal surgery.Multivariate

关 键 词：肠炎 耐甲氧西林金黄色葡萄球菌 胃肠道手术 因素分析 

分 类 号：R656[医药卫生—外科学]