连续5年骨科手术患者手术部位感染病原学特点及其危险因素  

Characteristics of pathogens and risk factors of surgical site infection in orthopedic patients in five consecutive years

作　　者：李发祥[1] 崔钢华 申晓坤 黄新玲[1] 王维山[1] 史晨辉[1] 

机构地区：[1]石河子大学医学院第一附属医院,新疆石河子832000

出　　处：《中国感染控制杂志》2016年第7期466-470,共5页Chinese Journal of Infection Control

基　　金：国家自然科学基金(81160225;81260453;81360451);新疆兵团医药卫生专项资助(2013BA020);兵团国际交流与合作专项资助(2012BC002;2011BC004);兵团科技创新团队专项基金(2014CC002)

摘　　要：目的调查骨科手术患者手术部位感染(SSI)发病情况,并分析其危险因素,为预防和控制SSI提供依据。方法回顾性调查某院2010年1月—2014年12月骨科所有住院手术患者,设计调查表,查阅患者病历资料,分析其SSI发生情况,并采用单因素及logistic回归分析SSI的危险因素。结果共调查14 300例骨科手术患者,发生SSI 576例,发病率为4.03%;以表浅切口感染为主(429例,占74.48%)。576例SSI患者共检出病原菌615株,主要为金黄色葡萄球菌(137株,占22.28%)、大肠埃希菌(84株,占13.66%)和阴沟肠杆菌(73株,占11.87%)。2010—2014年骨科手术患者SSI发病率逐年下降(χ2=24.706,P<0.001);截肢术患者SSI发病率最高(22.67%),其次为清创术患者(7.16%);logistic多因素回归分析结果显示,手术持续时间长、住院时间长、有基础疾病、有植入物、切口污染程度高、术中出血量大、围手术期抗菌药物使用不合理以及术后未使用负压引流均为骨科手术患者SSI的独立危险因素。结论骨科手术患者SSI发病率较高,应根据SSI感染的相关危险因素积极采取有效预防控制措施,降低骨科手术患者SSI的发生。Objective To investigate the incidence of surgical site infection （SSI）in patients undergoing orthopedic surgery,analyze the risk factors,and provide basis for the prevention and control of SSI.Methods All hospitalized orthopedic patients undergoing surgery in a hospital from January 2010 to December 2014 were retrospectively sur-veyed,questionnaires were designed,patients’medical records were reviewed,incidence of SSI was analyzed,risk factors for SSI were analyzed with univariate and logistic regression methods.Results A total of 14 300 orthopedic patients undergoing surgery were investigated,576 （4.03%）patients had SSI,predominantly were superficial inci-sion infection （n=429,74.48%）,615 strains of pathogenic bacteria were isolated from 576 patients,mainly were Staphylococcus aureus （n=137,22.28%）,Escherichia coli （n=84,13.66%）,and Enterobacter cloacae （n=73, 11 .87%）.The incidence of SSI decreased year by year in patients undergoing orthopedics surgery（χ2 =24.706,P ＆lt;0.001）;the incidence of SSI in patients with amputation was the highest （22.67%）,followed by patients with de-bridement （7.16%）;multivariate logistic regression analysis indicated that long duration of operation,long length of hospital stay,underlying diseases,use of implants,contaminated incision,more intraoperative blood loss,irra-tional perioperative use of antimicrobial agents,and without using negative pressure drainage were independent risk factors for SSI in patients undergoing orthopedic surgery.Conclusion The incidence of SSI is high in orthopedic pa-tients undergoing surgery,effective preventive measures should be actively taken according to the related risk factors of SSI,so as to reduce the occurrence of SSI.

关 键 词：骨科 手术部位感染 病原菌 危险因素 LOGISTIC 回归分析 

分 类 号：R619.3[医药卫生—外科学]