口腔鳞状细胞癌患者术后切口感染病原菌特点及感染危险因素分析

Analysis of pathogenic bacteria characteristics and infection-related risk factors of postoperative incision infection in patients with oral squamous cell carcinoma

目的:研究口腔鳞状细胞癌(OSCC)患者术后切口感染情况,分析病原菌特点及感染的相关危险因素。方法:回顾分析2020年1月至2022年5月在南京医科大学附属口腔医院颌面外科进行初次手术治疗的644例OSCC患者的临床资料,统计术后切口感染的病原菌分布及其药敏结果,采用单因素和多因素逐步回归分析术后切口感染的独立危险因素。结果:644例OSCC患者中,发生术后感染42例,感染率为6.5%,主要病原菌有铜绿假单胞菌(21.4%)、金黄色葡萄球菌(14.3%)和阴沟肠杆菌(14.3%)。分离出的革兰阴性杆菌对青霉素类和头孢菌素类耐药率较高,对磺胺类和喹诺酮类较敏感,革兰阳性球菌中的葡萄球菌属对青霉素类耐药率较高,对万古霉素类较敏感。肿瘤>35 mm、手术时间>5 h、糖尿病史、术中输血、长期吸烟史为OSCC术后切口感染的独立危险因素(P<0.05)。结论:OSCC患者术后切口感染率较高,对患者切口分泌物及时进行细菌培养,可指导临床使用合适的抗菌药物。同时应根据术前、术中情况对患者进行感染风险评估,采取相应的预防措施,有效降低患者术后切口感染率,缩短恢复时间,提高生存质量。

Objective:To investigate the incidence of postoperative incision infection in patients with oral squamous cell carcinoma(OSCC),and to analyze pathogenic bacteria characteristics and infection-related risk factors.Methods:The clinical data of 644 OSCC patients who underwent primary surgery from January 2020 to May 2022 at the Department of Oral and Maxillofacial Surgery in the Affiliated Hospital of Stomatology of Nanjing Medical University were retrospectively analyzed.The distribution of pathogenic bacteria and their antimicrobial susceptibility were studied.Univariate and multivariate stepwise regression analyses were used to analyze the independent risk factors of postoperative incision infection.Results:Among the 644 OSCC patients,42 cases were infected,with an infection rate of 6.5%.The main pathogens were Pseudomonas aeruginosa(21.4%),Staphylococcus aureus(14.3%)and Enterobacter cloacae(14.3%).The isolated gram-negative bacteria were resistant to penicillins and cephalosporins,and sensitive to sulfonamides and quinolones.The Staphylococcus species in gram-positive cocci were resistant to penicillins and sensitive to vancomycin.Tumor diameter>35 mm,operation time>5 hours,history of diabetes,intraoperative blood transfusion and long-term smoking history were independent risk factors for postoperative incision infection in OSCC patients(P<0.05).Conclusion:OSCC patients have a high rate of postoperative incision infection.Timely pathogens culture should be conducted on patients'incision secretions,which can guide the rational use of antibiotics in clinical practice.Meanwhile,the patients'infectious risk should be evaluated according to their preoperative and operative status,and corresponding preventive measures need to be taken to reduce the incidence of postoperative incision infection,to shorten the recovery time,and to improve patients'quality of life.