基于WHO监测策略分析的清洁切口乳腺手术部位感染危险因素评价  

Risk factor analysis of surgical site infection in clean incision breast surgery based on WHO monitoring strategy

作　　者：赵晋[1] 陆天意 魏晓霞[1] 袁玉华[1] Zhao Jin;Lu Tianyi;Wei Xiaoxia;Yuan Yuhua(Department of Infection Prevention and Control,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院医院感染管理科,浙江杭州310016

出　　处：《实用肿瘤杂志》2022年第4期333-338,共6页Journal of Practical Oncology

摘　　要：目的通过分析清洁切口(Ⅰ类切口)乳腺手术部位感染(surgical site infection,SSI)的危险因素,比较我国和世界卫生组织(World Health Organization,WHO)监测策略对监测结果的可能影响,探讨清洁切口乳腺手术SSI的预防措施和科学监测策略。方法回顾性分析浙江大学医学院附属邵逸夫医院2018年1月至2020年12月行清洁切口乳腺手术的4121例患者的病例资料。收集患者基本情况(年龄、基础情况和疾病诊断)、手术情况[美国医院感染监测系统(National Nosocomial Infections Surveillance,NNIS)手术风险分级、美国麻醉医师协会(American Society of Anesthesiologists,ASA)麻醉分级和手术时长]、气温、抗菌药物使用情况和30 d出院监测资料等基本信息。采用χ^(2)检验和多因素Logistic回归对患者SSI进行危险因素分析。结果4121例患者中,发生SSI 31例,感染率为0.8%。感染病例病原学检出革兰阳性菌25株,占比92.6%;革兰阴性菌2株,占比7.4%。多因素分析显示,恶性肿瘤(P=0.007)、乳房再造(P<0.01)、气温(P=0.012)、手术时长(P=0.001)、NNIS手术风险分级标准(P=0.001)、术前住院时间(P=0.037)和围术期抗菌药物使用(P=0.027)是清洁切口乳腺SSI的危险因素。结论清洁切口乳腺SSI受多种因素的影响,标准化同质化的监测可获得更加准确的结果,利于开展机构间质控和比较。Objective To analyze the risk factors of surgical site infection(SSI)in clean(typeⅠ)incision breast surgery,compare the possible impact of surveillance strategies of China and the World Health Organization(WHO)on surveillance results,and explore preventive measures and scientific surveillance strategies for SSI in clean incision breast surgery.Methods This was a retrospective investigation on 4121 patients who underwent breast surgery with clean incision in Sir Run Run Shaw Hospital,Zhejiang University School of Medicine between January 2018 and December 2020.Demographic data(age,basic physical condition,and disease diagnosis),operation status[National Nosocomial Infections Surveillance(NNIS)classification,American Society of Anesthesiologists(ASA)classification and operative duration],temperature,use of antibiotics and monitoring data within 30 days after discharge were recorded for all patients.The risk factors of SSI were analyzed byχ^(2)test and multivariate logistic regression.Results Of the 4121 enrolled patients,31 developed SSI,with an SSI rate of 0.8%.Twenty-five strains of gram-positive bacteria(92.6%)and two strains of gram-negative bacteria(7.4%)were isolated.Multivariate logistic regression analysis showed that malignant tumor(P=0.007),breast reconstruction(P<0.01),temperature(P=0.012),operative duration(P=0.001),NNIS classification(P=0.001),postoperative length of hospital stay(P=0.037)and prophylactic usage of antibiotics(P=0.027)were independent risk factors of SSI in clean incision breast surgery.Conclusions SSI in clean incision breast surgery is affected by many factors.Standardized and homogeneous monitoring can obtain more accurate results,which is conducive to inter-agency quality control and comparison.

关 键 词：乳腺手术 手术部位感染 危险因素 监测策略 

分 类 号：R737.9[医药卫生—肿瘤]