外科手术后切口感染病原菌与耐药性及手术室影响因素  

Pathogenic bacteria distribution and drug resistance in incision infection after surgery and influencing factors in operating room

作　　者：胡君君 崔小妹 叶美妮 代燕琴 HU Jun-jun;CUI Xiao-mei;YE Mei-ni;DAI Yan-qin(Jiujiang University Affiliated Hospital,Jiujiang,Jiangxi 332000,China)

机构地区：[1]九江学院附属医院大外科,江西九江332000 [2]九江学院附属医院手术室,江西九江332000

出　　处：《中华医院感染学杂志》2021年第8期1277-1280,共4页Chinese Journal of Nosocomiology

基　　金：江西省卫健委基金资助项目(202131108)。

摘　　要：目的研究外科手术后切口感染病原菌分布及其耐药性,分析感染手术室影响因素。方法回顾性分析2019年1月-2019年12月九江学院附属医院9 917例外科手术患者临床资料,分析术后切口感染者感染状况及病原菌分布情况,对主要病原菌行耐药性分析,并采用非条件Logistic模型对外科手术患者性别、年龄及手术室相关因素进行单因素及多因素分析,评估术后切口感染的手术室影响因素。结果 9 917例外科手术患者出现术后切口感染39例,感染率0.39%。39例感染者中,以骨科患者居多,占比43.59%;感染部位则以表浅切口为主,占比53.85%;44株病原菌中,以革兰阳性菌为主,占比59.09%。行耐药性分析,发现10株金黄色葡萄球菌对青霉素耐药株数高达10株,对庆大霉素、万古霉素耐药较少,有2株耐药;7株大肠埃希菌对氨苄西林、哌拉西林耐药株数高达6株,对氨曲南耐药较少,有2株耐药。经Logistic回归分析,显示年龄≥60岁、手术时间≥3 h、有参观人员、是接台手术均为影响外科手术后切口感染的独立影响因素(OR=1.484、1.285、1.317、1.533,P<0.05)。结论外科手术后切口感染情况与患者自身状况及手术室管理情况均相关,手术室应针对危险因素制定防控措施,减少切口感染发生率,并注意抗菌药物管理,预防多药耐药菌感染。OBJECTIVE To study the distribution and drug resistance of pathogenic bacteria in incision infection after surgery and analyze the influencing factors for infection in operating room. METHODS The clinical data of 9,917 surgical patients in Jiujiang University Affiliated Hospital from Jan 2019 to Dec 2019 were retrospectively analyzed. The infection status and pathogenic bacteria distribution were analyzed among patients with incision infection after surgery, and drug resistance analysis was performed on major pathogenic bacteria. Unconditional Logistic model was used to perform univariate analysis and multivariate analysis on gender, age and operating room-related factors of surgical patients, and the influencing factors of incision infection after surgery in operating room were evaluated. RESULTS Among 9 917 surgical patients, there were 39 cases of postoperative incision infection, with an infection rate of 0.39%. Among 39 infected patients, orthopedic patients were the majority, accounting for 43.59%. Superficial incision was the main infection site, accounting for 53.85%. Among the 44 strains of pathogenic bacteria, Gram-positive bacteria was the main strain, accounting for 59.09%. Drug resistance analysis found that 10 strains of Staphylococcus aureus were all resistant to benzylpenicillin and 2 strains were resistant to sentamicin and vancomycin;6 in 7 strains of Escherichia coli were resistant to ampicillin and piperacillin and 2 strains were resistant to aztreonam. Logistic regression analysis found that age ≥60 years old, operative time ≥3 h, visitors and consecutive operation were independent risk factors affecting incision infection after surgery(OR=1.484, 1.285, 1.317, 1.533, P<0.05). CONCLUSION The incision infection after surgery is related to the self-condition of patients and the operating room management. It should be necessary to develop prevention and control measures to avoid risk factors in the operating room so as to reduce the incidence rate of incision infection, and attention should b

关 键 词：外科手术 切口感染 病原菌耐药性 手术室 影响因素 非条件Logistic 

分 类 号：R619[医药卫生—外科学]