糖尿病患者急性阑尾炎术后切口感染的危险因素分析

Risk factors for postoperative incision infections in diabetes patients complicated with acute appendicitis

目的调查糖尿病并发急性阑尾炎术后切口感染的病原菌及其耐药性特点,并对危险因素进行分析。方法回顾性分析2014年3月-2016年3月期间医院收治的159例糖尿病并发急性阑尾炎患者的细菌培养、药敏试验结果和临床资料情况。结果 159例糖尿病并发急性阑尾炎患者发生切口感染38例,感染率为23.90%;共分离得到46株病原菌,其中革兰阴性菌29株(63.04%),革兰阳性菌17株(36.96%);大肠埃希菌、铜绿假单胞菌及金黄色葡萄球菌均对氨苄西林、哌拉西林的耐药率较高(均>70.00%);χ~2检验分析,糖尿病并发急性阑尾炎术后切口感染与年龄、阑尾炎类型、住院时间、术前血糖、术后血糖和手术时间呈显著相关性(P<0.05);Logistic回归模型分析显示,年龄、阑尾炎类型、术后血糖和手术时间是糖尿病并发急性阑尾炎术后切口感染的独立危险因素(P<0.05)。结论糖尿病并发急性阑尾炎术后切口感染以革兰阴性菌为主,耐药现象较为严重,危险因素较多,临床应根据药敏试验结果和相关因素采取针对性预防控制措施。

OBJECTIVE To investigate the distribution of pathogens causing postoperative incision infections in diabetes patients complicated with acute appendicitis,monitor the drug resistance,and analyze the risk factors.METHODS A total of 159 diabetes patients complicated with acute appendicitis who were treated in the hospital from Mar 2014 to Mar 2016 were enrolled in the study.The results of bacterial culture and drug susceptibility testing and the clinical data were retrospectively analyzed.RESULTS Of the 159 diabetes patients complicated with acute appendicitis,38 had incision infection,with the infection rate 23.90%.Totally 46 strains of pathogens were isolated,of which 29 （63.04 %） were gram-negative bacteria,and 17 （36.96 %） were gram-positive bacteria.The drug resistance rates of Escherichia coli,Pseudomonas aeruginosa,and Staphylococcus aureus to ampicillin and piperacillin were more than 70.00 %.The chi-square test showed that the incidence of postoperative incision infections in the diabetes patients complicated with acute appendicitis was significantly associated with age,types of appendicitis,length of hospital stay,preoperative blood glucose levels,postoperative blood glucose levels,and operation duration （P〈0.05）.The logistic regression model analysis indicated that the age,types of appendicitis,postoperative blood glucose levels,and operation duration were the independent risk factors for the postoperative incision infections in the diabetes patients complicated with acute appendicitis （P〈 0.05）.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the postoperative incision infections in the diabetes patients complicated with acute appendicitis and are highly drug-resistant.There are a variety of risk factors,and it is necessary to take targeted measures on the basis of the result of drug susceptibility testing and related factors.