成年手术患者手术部位多重耐药菌感染及影响因素分析

doi:10.12183/j.scjpm.2021.1245

摘要/Abstract

摘要： 目的探讨手术部位多重耐药（MDRO）菌感染情况及危险因素,为手术部位感染的预防和治疗提供循证参考。方法以2019—2020年焦作市某医院行手术治疗的成年患者作为研究对象,收集基本情况、疾病患者情况,从医院病历信息系统中调取患者手术及术前相关检测指标、用药情况等内容,对出现发热、切口红肿、引流液异常等疑似感染症状体征患者采集感染部位生物样本用于病原学培养及检测。采用描述流行病学分析方法对MDRO菌感染情况进行分析,并采用单、多因素分析方法对MDRO菌感染影响因素进行分析。结果 7 820例进行手术治疗患者共发生MDRO菌感染250例,感染率为3.20%,其中金黄色葡萄球菌感染6例,鲍曼不动杆菌感染14例,铜绿假单胞菌感染29例,肺炎克雷伯菌感染34例,大肠埃希菌感染167例。多因素Logistic回归分析显示,糖尿病（OR=3.578）、肿瘤（OR=4.135）、贫血（OR=4.701）、入住ICU（OR=5.045）、脏器穿孔（OR=2.414）、切口分类为Ⅱ或Ⅲ类（OR=2.284、3.013）、手术有风险（OR=5.135）、抗菌药物应用≥2种（OR=2.340）、抗菌药物疗程≥5 d（OR=4.759）、再手术（OR=2.036）是成年手术患者发生MDRO菌感染的危险因素。结论成年手术患者手术部位MDRO菌感染较为常见,相关危险因素较多,临床可根据以上因素加强围手术管理,减少MDRO菌感染的发生。

关键词: 手术感染, 多重耐药菌, 病原分布, 影响因素

Abstract: Objective To explore the multi-drug resistant organism （MDRO） infection at the surgical site and its risk factors, so as to provide evidence-based reference for the prevention and treatment of surgical site infection. Methods From 2019 to 2020, the adult patients who underwent surgical treatment in a hospital in Jiaozuo were selected as the research objects. The basic information and the condition of the patients were collected, and the patients' surgery and preoperative related test indicators and medication status were collected from the hospital medical record information system. Biological samples of infected sites were collected from patients with suspected infection symptoms and signs such as fever, incision redness and swelling, and abnormal drainage fluid for pathogen culture and detection. Descriptive epidemiological analysis method was used to analyze the MDRO infection, and univariate and multivariate analysis methods were used to analyze its influencing factors. Results A total of 250 MDRO infections occurred in 7 820 patients, and the MDRO infection rate was 3.20%. There were 6 cases of Staphylococcus aureus infection, 14 cases of Acinetobacter baumanii infection, 29 cases of Pseudomonas aeruginosa infection, 34 cases of Klebsiella pneumoniae infection, and 167 cases of Escherichia coli infection. Multivariate Logistic regression analysis showed that diabetes （OR=3.578）, tumor （OR=4.135）, anemia （OR=4.701）, admission to ICU （OR=5.045）, organ perforation （OR=2.414）, incision classification was class Ⅱ or Ⅲ （OR=2.284, 3.013）, risk surgery （OR=5.135）, application of antibacterial drugs ≥2 kinds （OR=2.340）, antibacterial treatment course ≥5 d （OR=4.759）, and reoperation （OR=2.036） were the risk factors of MDRO infection in adult surgical patients. Conclusion MDRO infection at the surgical site of adult surgical patients is common, and there are many related risk factors. Clinically, perioperative management can be strengthened according to the above factors to reduce the incidence of MDRO infection.

Key words: Surgical site infection, Multi-drug resistant organism, Pathogen distribution, Influencing factor

中图分类号:

R195

职统利, 卢明, 田春梅, 孟明哲, 张金盈. 成年手术患者手术部位多重耐药菌感染及影响因素分析[J]. 华南预防医学, 2021, 47(10): 1245-1249.

ZHI Tong-li, LU Ming, TIAN Chun-mei, MENG Ming-zhe, ZHANG Jin-ying. Multi-drug resistant organism infection at surgical site of adult surgical patients and its influencing factors[J]. South China Journal of Preventive Medicine, 2021, 47(10): 1245-1249.

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