口腔颌面恶性肿瘤患者术后医院感染及危险因素分析

Risk factors for postoperative healthcare-associated infection in patients undergoing oral and maxillofacial malignant tumor surgery

目的了解口腔颌面恶性肿瘤患者术后医院感染的危险因素,以采取有效的干预措施,降低医院感染的发生。方法采用前瞻性和回顾性调查相结合的方法,对2013年某院口腔颌面恶性肿瘤手术患者医院感染情况及相关危险因素进行分析。结果 432例口腔颌面恶性肿瘤患者中,发生医院感染58例,63例次,医院感染率为13.43%,感染例次率为14.58%。感染部位以下呼吸道和手术部位为主,分别占57.14%和38.09%。分离病原菌56株,以铜绿假单胞菌为主(46.43%),其次为鲍曼不动杆菌和肺炎克雷伯菌。单因素分析结果显示,气管切开、住院时间、手术时间、术中抗菌药物的使用情况是口腔颌面恶性肿瘤患者发生医院感染的危险因素(均P<0.05)。结论尽可能缩短手术和住院时间,采取主动干预,切实落实手卫生,合理使用抗菌药物是降低口腔颌面恶性肿瘤手术患者医院感染的重要措施。

Objective To realize the risk factors for postoperative healthcare-associated infection （HAI）in pa-tients undergoing oral and maxillofacial malignant tumor surgery,so as to take effective intervention measures and reduce the occurrence of HAI.Methods Prospective and retrospective survey were adopted to analyze the occur-rence of HAI and related risk factors for postoperative HAI in patients undergoing oral and maxillofacial malignant tumor surgery in 2013.Results Of 432 patients,58 developed 63 times of HAI,HAI rate was 13.43%,case infec-tion rate was 14.58%.The main infection sites were lower respiratory tract （57.14%）and surgical site （38.09%）. 56 pathogenic strains were isolated,the major were Pseudomonas aeruginosa （46.43%）,followed by Acinetobacter baumannii and Klebsiella pneumonia .Univariate analysis revealed that tracheotomy,length of hospital stay,opera-tive time,intraoperative antimicrobial use were risk factors for HAI in patients undergoing oral and maxillofacial malignant tumor surgery（all P 〈0.05）.Conclusion The important measures for reducing HAI in patients undergo-ing oral and maxillofacial malignant tumor surgery are shortening the duration of surgery and length of hospital stay, taking active intervention,implementing hand hygiene,and using antimicrobial agents rationally.