肛肠疾病手术切口感染病原菌的临床调查分析

Study on pathogenic bacteria causing surgical incision infections in patients with anorectal disease

目的分析肛肠疾病手术切口感染(SSI)的病原菌特点,并分析了其相关的危险因素,以期为肛肠疾病SSI的预防治疗提供科学依据。方法回顾性分析医院2010年7月-2012年6月因肛肠疾病手术的患者临床资料287例,统计分析肛肠疾病患者SSI的危险因素。结果 287例肛肠疾病手术患者共有59例发生SSI,感染率为20.6%,其中痔疮感染38例感染率为20.4%、肛瘘12例感染率为20.7%、肛裂9例感染率为20.9%,3组之间差异无统计学意义;59例SSI患者中共分离培养出病原菌38株,阳性率为64.4%,其中革兰阴性菌占了81.5%,革兰阳性菌占了13.2%,真菌占了5.3%;革兰阴性菌主要以大肠埃希菌、变形菌属、克雷伯菌属和肠杆菌属为主,分别占了42.1%、15.8%、10.5%和7.9%,革兰阳性菌以肠球菌属和表皮葡萄球菌为主,分别占了7.9和5.3%;单因素χ2检验显示,年龄>40岁、手术时间>100min,体重指数(BMI)≥25的患者具有较高的SSI发生率(P<0.05)。结论肛肠疾病术后具有高的SSI发生率,感染的病原菌主要是革兰阴性菌,患者的年龄、手术时间和BMI是其SSI发生的高危因素,积极采取相应的预防措施有利于降低肛肠疾病SSI的发生。

OBJECTIVE To investigate the characteristics of pathogenic bacteria causing surgical incision infections in the patients with anorectal disease and to explore the related risk factors so as to provide scientific basis for the prevention of surgical incision infections.METHODS The clinical data of 287 patients with anorectal diseases who underwent surgery from Jul 2010 to Jun 2012 were retrospectively analyzed,and the risk factors of surgical incision infections in the patients were statistically analyzed.RESULTS Of totally 287 cases of patients investigated,the surgical incision infections occurred in 59 cases with the infection rate of 20.6%,among which there were 37（20.4%）cases with hemorrhoids infections,12（20.7%）cases with anal fistula,and 9（20.9%）cases with anal fissure,the difference between the three groups was not statistically significant.Totally 38 strains of pathogens were isolated from the 59 patients with surgical incision infections with the positive rate of 64.4%,among which the gram-negative bacteria accounted for 81.5%,the gram-positive bacteria accounted for 13.2%,and the fungi accounted for 5.3%.The Escherichia coli,Proteus mirabilis,Klebsiella,and Enterobacter were the main gram-negative bacteria,accounting for 42.1%,15.8%,10.5%,and 7.9%,respectively.Enterococci and Staphylococcus epidermidis were the main gram-positive bacteria,accounting for 7.9 and 5.3%,respectively.The χ2 analysis showed that the incidence of the surgical incision infections was closely related to the more than 40 years of age,operation duration more than 100min,and BMI higher than 25（P0.05）.CONCLUSION The incidence of surgical incision infections is high in the patients with anorectal disease after surgery.The gram-negative bacteria are the predominant pathogens causing the infections.The age,operative duration and BMI are the high-risk factors for the surgical incision infections.Taking appropriate prevention measures may contribute to the decrease of the surgical incision infections in the patients with anorectal disease.