行口腔颌面外科术患者术后感染病原学特征及相关因素分析  

Analysis of etiological characteristics and related factors of postoperative infections in patients undergoing oral and maxillofacial surgery

作　　者：张建丽[1] 刘玉坤 任起辉[3] 胡杰 简雪峰[5] 谷峰 ZHANG Jian-li;LIU Yu-kun;REN Qi-hui;HU Jie;JIAN Xue-feng;GU Feng(The First Affiliated Hospital of Henan University of Science and Technology, Henan University of Science and Technology, Luoyang, Henan 471003, China)

机构地区：[1]河南科技大学临床医学院河南科技大学第一附属医院口腔科病房,河南洛阳471003 [2]河南科技大学临床医学院河南科技大学第一附属医院医院感染管理科,河南洛阳471003 [3]河南科技大学临床医学院河南科技大学第一附属医院口腔科门诊,河南洛阳471003 [4]河南科技大学临床医学院河南科技大学第一附属医院手术室,河南洛阳471003 [5]河南科技大学临床医学院河南科技大学第一附属医院检验科,河南洛阳471003

出　　处：《中华医院感染学杂志》2018年第3期440-443,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨行口腔颌面外科手术患者术后感染病原菌的特征及相关因素分析。方法选取2014年1月-2016年12月医院收治的口腔颌面外科手术患者386例为研究对象,观察患者术后感染发生情况、感染部位。分离感染患者菌株进行鉴定,分析术后感染病原菌特征及相关因素。结果 386例口腔颌面手术患者术后发生感染31例,感染率为8.03%,感染部位以呼吸道和手术切口为主;共培养分离病原菌40株,其中革兰阴性菌31株占77.50%,以铜绿假单胞菌为主;革兰阳性菌7株占17.50%,以金黄色葡萄球菌为主;真菌2株占5.00%;分离出的铜绿假单胞菌对哌拉西林和头孢唑林的耐药率较高,对环丙沙星等抗菌药物比较敏感;分离出的金黄色葡萄球菌对庆大霉素耐药率较高,对万古霉素敏感;年龄、手术时间、伤口有异物、误吸及侵入性操作是患者感染的相关因素(P<0.05),抗菌药物使用则能降低患者感染的风险。结论口腔颌面外科手术后感染发生率较高,应当针对性地给予抗菌药物,同时尽量避免可能引起术后感染的相关因素。OBJECTIVE To investigate the characteristics of pathogen infection after oral and maxillofacial surgery, and analyze the influencing factors of infections.METHODS A total of 386 patients with oral and maxillofacial sur- gery in our hospital from Jan. 2014 to Dec. 2016 were chosen in this study. The infection occurrence and infection sites of the patients after surgery were observed. The isolated strains of infected patients were identified, and the characteristics of pathogens and influencing factors of infections were analyzed. RESULTS Totally 31 cases were in- fected in the 386 cases of patients with oral and maxillofacial surgery, and the infection rate was 8.03%. Among them, respiratory infections and surgical incision infections were the main infection sites. A total of 40 pathogens were isolated and cultured, including 31 strains of gram-negative bacteria, accounting for 77.50%, mainly Pseud- ornonas aeruginosa, 7 strains of gram-positive bacteria, accounting for 17.50%, mainly Staphylococcus aureus, and 2 strains of fungi , accounted for 5.00%. The isolated P. aeruginosa had high resistant rates to piperacillin and eefazolin , and was sensitive to antibiotics such as ciprofloxacin. The isolated S. aureus had high resistant rate to gentamicin, and was sensitive to vancomycin. Age, time of operation, whether the wound had foreign body, as- piration and invasive operation could increase the independent risk factors for infections （P〈0.05）, and the use of antimicrobial drugs could reduce the risk of infections. CONCLUSION The incidence of infections after oral and maxillofacial surgery is high, antibiotics should be targeted, and the risk factors of postoperative infections should be avoided as far as possible.

关 键 词：口腔颌面外科手术 病原菌 感染特征 相关因素 

分 类 号：R378[医药卫生—病原生物学]