口腔颌面外科患者术后感染的病原菌及相关因素分析

Pathogens causing postoperative infection in patients undergoing oral and maxillofacial surgery and related influencing factors

目的探讨口腔颌面外科患者术后感染的病原菌及感染相关影响因素,为临床预防口腔颌面外科患者术后感染和制定应对措施提供临床依据。方法回顾性分析医院2013年4月-2016年4月接诊的2 100例口腔颌面外科患者的临床资料,统计分析术后感染率、感染部位分布、病原菌分布及引发口腔颌面外科患者术后感染的相关影响因素;对感染患者的送检标本进行病原菌培养鉴定,使用仪器为美国Biolog公司全自动细菌鉴定仪;采用SPSS18.0软件进行统计分析。结果 2 100例口腔颌面外科患者中,术后发生感染14例,术后感染率为0.67%;14例术后感染患者的感染部位以下呼吸道为主,5例占35.71%,其次为上呼吸道感染,4例占28.57%;14例术后感染患者共分离出25株病原菌,其中革兰阴性菌14株占56.00%,以铜绿假单胞菌和克雷伯菌属为主,分别占32.00%和12.00%;革兰阳性菌11株占44.00%,以金黄色葡萄球菌为主,占36.00%;相关因素分析结果显示,年龄≥50岁、伤口异物、使用抗菌药物及手术时间≥3h为口腔颌面外科患者术后感染的影响因素(P<0.05)。结论影响口腔颌面外科患者术后感染的相关因素较多,且感染大多数因多种影响因素互相关联而引起,临床应针对上述因素制定针对性预防措施进行干预,以降低术后感染率。

OBJECTIVE To explore the pathogens causing postoperative infections in patients undergoing oral and maxillofacial surgery and analyze the related influencing factors for the infections so as to provide clinical basis for prevention of the postoperative infections and put forward the countermeasures.METHODS The clinical data of 2 100 patients who were treated in department of oral and maxillofacial surgery of the hospital from Apr 2013 to Apr 2016 were retrospectively analyzed.The incidence of postoperative infections,distribution of infection sites,distribution of pathogens,and related influencing factors for the postoperative infections were statistically analyzed;the submitted specimens that were obtained from the patients with the infections were cultured for pathogens,the isolated pathogens were identified by using automatic bacteria identification system of Biolog company;the statistical analysis was performed with the use of SPSS18.0 software.RESULTS Of the 2 100 patients who underwent the oral and maxillofacial surgery,14 had the postoperative infections,with the infection rate 0.67%.Among the 14 patients with the postoperative infections,5 （35.71%） had lower respiratory tract infections,and 4 （28.57%） had upper respiratory tract infections.A total of 25 strains of pathogens were isolated from the 14 patients with the postoperative infections,of which 14 （56.00%） were gram-negative bacteria,and 11 （44.00%）were gram-positive bacteria;Pseudomonas aeruginosa and Klebsiella were dominant among the gram-negative bacteria,accounting for 32.00% and 12.00%,respectively;Staphylococcus aureus was the predominant species of the gram-positive bacteria,accounting for 36.00%.The result of analysis of the related factors revealed that the no less than 50 years of age,foreign body of wound,use of antibiotics,and operation duration no less than 3 hours were the influencing factors for the postoperative infections in the patients undergoing the oral and maxillofacial surgery （P〈0.05）.CONCLUSION There are a variety of related factors for the postoperative infections in the patients undergoing the oral and maxillofacial surgery,and the infections are mainly caused by the interaction of multiple influencing factors;it is necessary for the hospital to take targeted intervention measures according to the above factors so as to reduce the incidence of the postoperative infections.