急诊外科胸腹部创伤手术后切口感染的病原菌分布及相关危险因素分析

Distribution of pathogens causing postoperative incision infection in emergency surgery department patients with thoracoabdominal trauma and related risk factors

目的调查急诊外科胸腹部创伤手术后切口感染的病原菌分布状况,分析相关危险因素。方法回顾性分析2012年3月-2016年3月医院急诊外科528例胸腹部创伤患者的细菌培养结果和临床资料,进行菌种鉴定及统计分析。结果 528例胸腹部创伤患者中发生术后切口感染患者56例,感染率为10.6%;共分离出病原菌72株,以革兰阳性菌为主,占48.6%,革兰阴性菌占44.4%,真菌占6.9%;单因素分析结果显示,急诊外科胸腹部创伤手术后切口感染与年龄、手术时间、住院时间、低白蛋白血症、合并糖尿病和围手术期抗菌药物使用呈明显相关性(χ2=20.420、7.326、12.274、10.254、4.238和11.689,P<0.05);logistic回归分析结果显示,年龄、住院时间、合并糖尿病和围手术期抗菌药物使用是急诊外科胸腹部创伤手术后切口感染的独立危险因素(OR=7.126、9.852、4.312和6.597,P<0.05)。结论急诊外科胸腹部创伤手术后切口感染以革兰阳性菌为主,年龄、住院时间、合并糖尿病和围手术期抗菌药物使用是其发生的独立危险因素,临床应采取有效措施,控制切口感染的发生。

OBJECTIVE To investigate the distribution of pathogens causing postoperative incision infection in emer- gency surgery department patients with thoracoabdomial trauma and analyze the related risk factors. METHODS The bacterial culture results and clinical data of 528 patients with thoracoabdominal trauma who were treated in the emergency surgery department from Mar 2012 to Mar 2016 were retrospectively analyzed. The species of isolated pathogens were identified, and the statistical analysis was performed. RESULTS Of the 528 patients with thora- .coabdominal trauma, 56 had the postoperative incision infection, accounting for 10. 6%. A total of 72 strains of pathogens were isolated, of which 48.6% were gram-positive bacteria, 44.4% were gram-negative bacteria, and 6.9% were fungi. The result of univariate analysis indicated that the incidence of postoperative incision infection in the emergency surgery department patients with thoracoabdominal trauma was remarkably associated with the age, operation duration, length of hospital stay, hypoalbuminemia, complication with diabetic mellitus, and periopera- tive use of antibiotics （X^2 =20. 420, 7. 326, 12. 274, 10. 254, 4. 238, and 11. 689,P〈0.05）. The results of logis- tic regression analysis showed that the independent risk factors for the postoperative incision infection in the emer- gency surgery department patients with thoracoahdominal trauma included the age, length of hospital stay, com- plication with diabetic mellitus, and perioperative use of antibiotics （OR=7. 126, 9. 852, 4. 312, and 6. 597, P〈0.05）. CONCLUSION The gram-positive bacteria are dominant among the pathogens causing the postoperative inci- sion infection in the emergency surgery department patients with thoracoabdominal trauma. The independent risk factors for the infection include the age, length of hospital stay, complication with diabetic mellitus, and perioper- ative use of antibiotics. It is necessary for the hospital to take effective measures so as to control the incision infec- tion.