眼科手术后感染性眼内炎的危险因素及预测模型的构建  

Risk factors for postoperative infectious endophthalmitis in patients undergoing ophthalmologic surgery and establishment of prediction model

作　　者：李泽琼 许路加[1] 杨倩倩[1] 郑檀 关微 LI Ze-qiong;XU Lu-jia;YANG Qian-qian;ZHENG Tan;GUAN Wei(Zhengzhou Seventh People's Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州市第七人民医院眼科,河南郑州450000

出　　处：《中华医院感染学杂志》2023年第1期86-89,共4页Chinese Journal of Nosocomiology

基　　金：河南省科研基金资助项目(2019116)。

摘　　要：目的 探究眼科手术后感染性眼内炎发生的危险因素,并构建预测模型。方法 选取2019年3月-2021年3月郑州市第七人民医院收治的97例眼科手术后感染性眼内炎患者为感染组,并以同期未出现感染性眼内炎的患者298例为非感染组,分析感染病原菌分布及眼科术后并发感染性眼内炎的危险因素,并建立预测模型。结果 本研究纳入的97例感染性眼内炎患者前房房水、玻璃体液标本共检出病原菌89株,其中革兰阳性菌60株占67.42%,革兰阴性菌25株占28.09%,真菌4株占4.49%;合并糖尿病、手术类型为内眼手术、有眼外伤史、手术时长≥20 min是眼科术后并发感染性眼内炎的独立危险因素(P<0.05);多元Logistics回归方程获得眼科术后并发感染性眼内炎的预测模型,Hosmer-Lemeshow检验结果显示,模型与观测值拟合度较好(χ^(2)=1.878,P=0.758)。受试者工作特征(ROC)曲线分析结果显示,该模型预测术后感染性眼内炎的曲线下面积(AUC)为0.798(95%CI:0.710~0.887),敏感度为87.63%,特异度为84.23%。结论 革兰阳性菌为眼科手术后并发感染性眼内炎的主要致病菌,合并糖尿病、手术类型为内眼手术、有眼外伤史、手术时长≥20 min是导致患者术后并发感染性眼内炎的危险因素,且所构建的预测模型对眼科手术后感染性眼内炎风险具有预测价值。OBJECTIVE To explore the risk factors for postoperative infectious endophthalmitis in patients undergoing ophthalmologic surgery and establish the prediction model. METHODS A total of 97 patients who underwent ophthalmologic surgery and had postoperative infectious endophthalmitis in Zhengzhou Seventh People′s Hospital from Mar 2019 to Mar 2021 were assigned as the infection group, meanwhile, 298 patients who did not have infectious endophthalmitis were chosen as the non-infection group. The distribution of pathogens and risk factors for the postoperative infectious endophthalmitis were observed, and the prediction model was established. RESULTS Totally 89 strains of pathogens were isolated from anterior aqueous humour and vitreous humor specimens of the 97 patients with infectious endophthalmitis, 60(67.42%) of which were gram-positive bacteria, 25(28.09%) were gram-negative bacteria, and 4(4.49%) were fungi. Complication with diabetes mellitus, intraocular surgery, history of ocular trauma and operation duration no less than 20 min were the independent risk factors for the postoperative infectious endophthalmitis in the patients undergoing ophthalmologic surgery(P<0.05). The prediction model for postoperative infectious endophthalmitis was acquired and established based on multivariate logistics regression equation, the result of Hosmer-Lemeshow test showed that the degree of fitting between the model and the observed value was good(χ~2=1.878,P=0.758). The result of receiver operating characteristic(ROC) curve analysis indicated that the area under curve(AUC) of the model was 0.798(95%CI:0.710~0.887) in prediction of the postoperative infectious endophthalmitis, with the sensitivity 87.63%, the specificity 84.23%. CONCLUSION The gram-positive bacteria are dominant among the pathogens isolated from the ophthalmologic surgery patients with postoperative infectious endophthalmitis. Complication with diabetes mellitus, intraocular surgery, history of ocular trauma and operation duration no less than 20 min are t

关 键 词：眼科手术 术后感染 感染性眼内炎 临床特点 感染性特征 危险因素 预测模型 

分 类 号：R771[医药卫生—眼科]