脊柱术后患者医院感染的病原学与危险因素分析

Etiological characteristics of postoperative nosocomial infections in patients undergoing spinal surgery and analysis of risk factors

目的研究脊柱术后患者医院感染的病原学特点与相关因素,为临床治疗提供依据。方法选取2011年8月-2015年8月在医院行脊柱手术治疗的患者1 000例,分析其术后医院感染情况及相关影响因素;使用SPSS17.0软件进行数据处理和统计分析,对发生医院感染的危险因素实施实施单因素、多因素logistic分析。结果 1 000例脊柱术后患者发生医院感染76例,感染率为7.60%,其中肺部感染36例占47.37%,泌尿系感染20例占26.31%,切口浅层及椎间隙17例占22.37%,深静脉置管3例占3.95%;共检测出病原菌80株,其中革兰阴性菌42株占52.50%,革兰阳性菌34株占42.50%,真菌4株占5.00%;单因素分析显示,手术时间、抗菌药物种类、经验性应用抗菌药物、置入材料、住院时间以及糖尿病与脊柱术后患者并发医院感染有关(P<0.05);logistic多因素分析显示,未经验性应用抗菌药物、置入材料以及合并糖尿病是脊柱术后患者并发医院感染的独立危险因素(P<0.05)。结论脊柱术后患者医院感染以肺部为主,革兰阴性菌是主要病原菌,临床应经验性应用抗菌药物、避免手术置入材料以及对合并糖尿病患者区别治疗来预防脊柱术后患者医院感染的发生。

OBJECTIVE To investigate the etiological characteristics of postoperative nosocomial infections in patients undergoing spinal surgery and analyze the related factors so as to provide guidance for clinical treatment.METHODS A total of 1 000 patients who underwent the spinal surgery in the hospitals from Aug 2011 to Aug 2015 were enrolled in the study,then the prevalence of postoperative nosocomial infections and the related influencing factors were analyzed,the statistical analysis of data was conducted with the use of SPSS17.0software,and the univariate analysis and multivariate logistic analysis were performed for the risk factors for the nosocomial infections.RESULTS Of 1 000 patients undergoing the spinal surgery,76 had postoperative nosocomial infections with the infection rate of 7.60%,of whom 47.37%（36cases）had pulmonary infections,26.31%（20cases）had urinary system infections,22.37%（17cases）had superficial incision and vertebral space infections,and 3.95%（3cases）had deep venous catheter-related infections.Totally 80 strains of pathogens were isolated,including 42（52.50%）strains of gram-negative bacteria,34（42.50%）strains of gram-positive bacteria,and 4（5.00%）strains of fungi.The univariate analysis showed that the complication of postoperative nosocomial infections was associated with the operation duration,types of antibiotics,empirical use of antibiotics,inserted materials,length of hospital stay,and diabetic mellitus（P〈0.05）.The multivariate logistic analysis indicated that the independent risk factors for the postoperative nosocomial infections included the non-empirical use of antibiotics,inserted materials,and complication of diabetic mellitus（P〈0.05）.CONCLUSION The patients with pulmonary infections are dominant among the patients with nosocomial infections after the spinal surgery.The gram-negative bacteria are the major pathogens.It is necessary for the hospital to conduct the empirical use of antibiotics,avoid the inserted materials during the surgery,and make a differential treatment of the patients complicated with diabetic mellitus so as to prevent the postoperative nosocomial infections in the patients undergoing the spinal surgery.