基于国家手术部位感染监测网2018—2021年中国急诊腹部术后手术部位感染发生情况调查及其因素分析  

Investigation and factor analysis of postoperative surgical site infections in emergency abdominal surgery in China from 2018 to 2021 based on Chinese SSI Surveillance

作　　者：郑志强[1] 刘洋洋[1] 罗文强[1] 张洪微[1] 王宇译 王虹[2] 李学民 陈红平 李由[5] 金炜东 黄河[7] 管玉婷 张红妹[1] 李世宽[1] 任建安 王培戈[1] Zheng Zhiqiang;Liu Yangyang;Luo Wenqiang;Zhang Hongwei;Wang Yuyi;Wang Hong;Li Xuemin;Chen Hongping;Li You;Jin Weidong;Huang He;Guan Yuting;Zhang Hongmei;Li Shikuan;Ren Jian'an;Wang Peige(Department of Emergency Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Gastrointestinal Surgery,The Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Hepatopancreatobiliary Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450007,China;Department of Nosocomial Infection Management,Jinchen General Hospital,Jinchen 048006,China;Department of General Surgery,Zigong First People's Hospital,Zigong 643000,China;Department of General Surgery,General Hospital of Central Theater Command of PLA,Wuhan 430070,China;Department of General Surgery,The First Hospital of Shanxi Medical University,Taiyuan 030001,China;Research Institute of General Surgery,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China)

机构地区：[1]青岛大学附属医院急诊外科,青岛266000 [2]青岛大学附属医院胃肠外科,青岛266000 [3]郑州大学附属郑州中心医院肝胆胰外科,郑州450007 [4]晋城大医院感染管理科,晋城048006 [5]自贡市第一人民医院普通外科,自贡643000 [6]中部战区总医院普通外科,武汉430070 [7]山西医科大学第一医院普通外科,太原030001 [8]东部战区总医院、全军普通外科研究所、南京大学医学院附属金陵医院,南京210002

出　　处：《中华胃肠外科杂志》2023年第9期827-836,共10页Chinese Journal of Gastrointestinal Surgery

基　　金：泰山学者特聘专家基金项目(2018092901);江苏省医学创新中心(CXZX202217)。

摘　　要：目的调查中国急诊腹部手术(EAS)后发生手术部位感染(SSI)的情况,进一步探讨其风险因素,为EAS后防控SSI的出现提供参考依据。方法采用观察性研究的方法。对国家SSI监测网2018—2021年期间前瞻性录入接受EAS的患者信息数据进行回顾性分析,所有患者随访至术后30 d。分析数据包括患者的一般资料,围手术期相关临床数据包括术前血红蛋白和白蛋白及血糖水平、美国麻醉医师协会(ASA)评分、手术切口等级、是否肠道准备及其方式、是否备皮、手术部位、手术方式以及手术时间等资料。主要结局指标为EAS术后30 d内SSI的发生情况,包括SSI发生率、感染类型[浅部切口感染、深部切口感染和器官(腔隙)感染]以及分泌物及脓液培养结果;次要结局指标为术后30 d内病死率、术后重症监护室(ICU)入住率和入住时间、术后总住院时间以及住院费用。依据是否发生感染,将患者分为SSI组和非SSI组,采用单因素及多因素logistic回归分析EAS后SSI发生的风险因素。结果共纳入5491例接受EAS的患者,其中男性3169例,女性2322例。168例(3.1%)EAS术后发生SSI(SSI组),非SSI组患者5323例。SSI组中,浅部切口感染69例(41.1%),深部切口感染51例(30.4%),器官(腔隙)感染48例(28.6%);分泌物及脓液培养结果阳性者115例(68.5%),其中大肠埃希菌检出率最高为40.9%(47/115)。SSI组与非SSI组比较,性别及体质指数差异无统计学意义(均P>0.05);但SSI组年龄≥60岁者的比例[49.4%(83/168)比27.5%(1464/5323),χ^(2)=38.604,P<0.001]、伴有糖尿病和高血压患者的比例[11.9%(20/168)比4.8%(258/5323),χ^(2)=16.878,P<0.001;25.6%(43/168)比12.2%(649/5323),χ^(2)=26.562,P<0.001]以及术前血红蛋白<110 g/L者[27.4%(46/168)比13.1%(697/5323),χ^(2)=28.411,P<0.001]和白蛋白<30 g/L者[24.4%(41/168)比5.9%(316/5323),χ^(2)=91.352,P<0.001]比例均偏高;术前备皮占比偏低[66.7%(112/168)比75.9%(4039/5323),χ^(2)=7.491,P=0.006];术�Objective We investigated the incidence of surgical site infection(SSI)following emergency abdominal surgery(EAS)in China and further explored its risk factors,providing a reference for preventing and controlling SSI after EAS.Methods This was an observational study.Data of patients who had undergone EAS and been enrolled in the Chinese SSI Surveillance Program during 2018-2021were retrospectively analyzed.All included patients had been followed up for 30 days after surgery.The analyzed data consisted of relevant patient characteristics and perioperative clinical data,including preoperative hemoglobin,albumin,and blood glucose concentrations,American Society of Anesthesiologists(ASA)score,grade of surgical incision,intestinal preparation,skin preparation,location of surgical site,approach,and duration.The primary outcome was the incidence of SSI occurring within 30 days following EAS.SSI was defined as both superficial and deep incisional infections and organ/space infections,diagnoses being supported by results of microbiological culture of secretions and pus.Secondary outcomes included 30-day postoperative mortality rates,length of stay in the intensive care unit(ICU),duration of postoperative hospitalization,and associated costs.The patients were classified into two groups,SSI and non-SSI,based on whether an infection had been diagnosed.Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with SSI following EAS.Results The study cohort comprised 5491 patients who had undergone EAS,comprising 3169 male and 2322 female patients.SSIs were diagnosed in 168(3.1%)patients after EAS(SSI group);thus,the non-SSI group consisted of 5323 patients.The SSIs comprised superficial incision infections in 69(41.1%),deep incision infections in 51(30.4%),and organ or space infections in 48(28.6%).Cultures of secretions and pus were positive in 115(68.5%)cases.The most frequently detected organism was Escherichia coli(47/115;40.9%).There were no significant differences in sex

关 键 词：手术部位感染 急诊腹部手术 危险因素 

分 类 号：R656[医药卫生—外科学]