抗菌药物预防应用与术后医院感染的病例对照研究

Case-control study on relationship between preventive application of antibiotics and postoperative nosocomial infection

目的通过病例对照研究筛选出与抗菌药物预防应用有关的术后医院感染危险因素，以引起外科医务人员的重视，控制手术患者院内感染的发生。方法院内感染患者做为病例组，采用1：1配对的方法选择未发生院内感染的手术患者做为对照组，对抗菌药物相关医院感染危险因素进行分析，筛选出与院内感染发生密切相关的危险因素。结果对照组与病例组在抗菌药物预防应用是否合理、抗菌药物是否联用、术前给药时机、预防用药级别、抗菌药物预防使用种类数和天数方面有统计学意义（P〈0．05）；抗菌药物预防使用种类数过多、使用天数过长为手术患者院内感染的危险因素。结论采取切实有效的管理措施控制外科手术患者抗菌药物滥用现状，特别是控制抗菌药物预防使用种类、天数，对控制耐药菌的产生、减轻患者经济负担、提高医疗质量有重要意义。

Objective To find the risk factors of postoperative nosocomial infection which were related to preventive application of antibiotics, and feed them back to the surgical staffs, in order to enhance their awareness of reasonably using the antibiotics and control the occurrence of nosocomial infection of operative patients. Methods 88 postoperative infected patients were selected as the case group and another 88 uninfected patients as the control group. The risk factors of nosocomial infection related to the antibiotics were analyzed, and the risk factors closely associated with antibiotics were screened. Results There were statistical meanings in whether the preventive application of antibiotics reasonable, whether the antibiotics applied in combination, the time of preoperative administration, the degree of preventative drug, the amount of kinds of antibiotics and the days of applying the antibiotics （ P 〈 0. 05 ）. Multiple-variation Logistic Regression Analysis indicated that the related factors of postoperative infection were too many kinds of antibiotics being used and too long times for an antibiotic prophylaxis being used. Conclusions It has important meaning for controlling the production of drugresistant germ, reducing the patients＇ economics burden and improving the medical quality that controlling the abuse state of antibiotic among the surgical patients through effective measures, especially controlling the kind and duration of preventative application of antibiotics.