手术部位感染目标性监控及其危险因素多中心研究

Multicenter study on targeted monitoring of surgical site infection and risk factors

目的调查我国医院手术部位感染(SSI)情况及相关危险因素,为我国SSI的防治提供理论依据。方法对全国部分省及直辖市共29所医院大肠手术、腹式子宫切除术、股骨颈修复术和血管手术4类手术进行前瞻性监测,分析SSI的危险因素。结果共纳入6 309例手术,SSI发病率为1.60%,其中大肠手术SSI发病率为4.47%(74/1 655)、腹式子宫切除术为1.03%(22/2 139)、股骨颈修复术为0.21%(5/2 372)、血管手术为0.00%(0/143)。各地区SSI发病率比较,差异有统计学意义(χ2=114.213,P<0.05)。最常见的术后SSI类型为表浅切口感染,其次为深部切口感染。引起SSI最常见的病原菌为大肠埃希菌、肠球菌属细菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌和肺炎克雷伯菌。男性、手术持续时间长、NNIS评分高是发生SSI的独立危险因素。结论不同手术类型发生SSI风险不同,男性、手术持续时间长、NNIS评分高可增加术后SSI发病率。

Objective To investigate the status and risk factors of surgical site infection（SSI）in hospitals in China,so as to provide theoretical basis for the prevention and treatment of SSI.Methods Four types of surgeries（colorectal surgery,abdominal hysterectomy,femoral neck repair surgery,and vascular surgery）in 29 hospitals were monitored prospectively,risk factors for SSI were analyzed.Results A total of 6 309 surgical procedures were investigated,incidence of SSI was 1.60%.Incidences of SSI in patients receiving colorectal surgery,abdominal hysterectomy,femoral neck repair surgery,and vascular surgery were 4.47%（74/1 655）,1.03%（22/2 139）,0.21%（5/2 372）,and 0.00%（0/143）respectively.The incidences of SSI were different among different regions（χ^2=114.213,P〈0.05）.The most common SSI was superficial incisional infection,the next was deep incisional infection.The major pathogens causing SSI were Escherichia coli,Enterococcus spp.,coagulase negative staphylococcus,Staphylococcus aureus,and Klebsiella pneumoniae.The independent risk factors for SSI were male patients,long duration of surgery,and high NNIS score.Conclusion The risk of SSI is varied with different types of surgeries.Male,long duration of surgery,and high NNIS score can increase the risk of postoperative SSI.