普外科患者切口感染病原菌分布与相关因素分析

The prevalence of pathogenic bacteria infecting surgical sites in patients in General Surgery and an analysis of related factors

目的了解普外科患者切口感染的病原菌类型、分布与影响因素,为临床感染防控提供指导。方法收集2014-2016年1 637例普外科术后患者资料,分析患者切口感染病原菌分布情况。采用K-B法检测病原菌耐药性,SPSS21.0分析感染相关因素。结果 1 637例普外科手术患者术后感染131例,感染率8.00%;I型、II型、III型切口感染率分别为3.44%(17/494)、8.08%(76/941)、18.81%(38/202);胆囊手术、乳腺手术、甲状腺手术、胃部手术、疝修补术、胆管手术、结直肠手术、小肠手术、胰腺手术感染率分别为4.81%(21/437)、3.21%(9/280)、7.07%(14/198)、11.41%(21/184)、10.83%(17/157)、11.89%(17/143)、8.82%(9/102)、8.82%(9/102)和41.18%(14/34)。切口感染分离出病原菌74株,包括44株革兰氏阴性菌(59.46%)、27株革兰氏阳性菌(36.49%)和3株真菌(4.05%)。铜绿假单胞菌18株,鲍曼不动杆菌12株,大肠埃希菌6株,其他革兰氏阴性菌8株;金黄色葡萄球菌13株,肠球菌属5株,表皮葡萄球菌3株,其他革兰氏阳性菌6株;3株真菌均为白色假丝酵母菌。铜绿假单胞菌和金黄色葡萄球菌对头孢唑啉、环丙沙星、氨苄西林、阿米卡星、庆大霉素的耐药率分别为50.00%、72.22%、72.22%、22.22%、44.44%和46.15%、38.46%、23.08%、38.46%、30.77%。≥60岁患者感染率(10.51%)与<60岁患者(6.20%)相比,差异有统计学意义(χ2=10.0678,P<0.05);合并糖尿病患者感染率(11.04%)与未合并者(4.92%)相比,差异有统计学意义(χ2=20.8444,P<0.05);住院时间≥1个月患者感染率(12.10%)与住院时间<1个月者(4.86%)相比,差异有统计学意义(χ2=28.6044,P<0.05);手术时间>2h的患者感染率(12.72%)与手术时间≤2h患者(5.06%)相比,差异有统计学意义(χ2=30.8615,P<0.05);不同性别和切口长度患者感染率差异无统计学意义(P均>0.05)。年龄、合并糖尿病、住院时间以及手术时间是影响普外科患者切口感染发生的因素。结论普外科患者切口感染以革兰氏阴性菌为主,III型切口感染率高,主要病原菌对常用抗菌药物均产生了耐药性。年龄、合并糖尿病、住院时间以及手术时间是影响普外科患者切口感染发生的重要因素。

Objective To analyze the type and prevalence of pathogenic bacteria causing a surgical site infection in patients in General Surgery and factors related to surgical site infections in order to guide the prevention and control of infec- tions in clinical settings. Methods Clinical data were collected on 1,637 postoperative patients in General Surgery from 2014 2016, and the prevalence of pathogenic bacteria causing a surgical site infection in patients was analyzed. The drug resistance of pathogenic bacteria was detected using the K-B method, and factors related to infection were analyzed using SPSS 21.0. Results Of the 1 637 postoperative patients in General Surgery, 131 had a postoperative infection, for a rate of infection of 8.00%. An infection was noted in 3.44% of patients undergoing type I surgery （17/494）, in 8.08% of patients undergoing type II surgery （76/941）, and in 18.81% of patients undergoing type III surgery （38/202）. The rate of infection was 4.81% （21/437） in patients undergoing gallbladder surgery, 3.21% （9/280） in patients undergoing breast surgery, 7.07% （14/198） in patients undergoing thyroid surgery, 11.41% （21/184） in patients undergoing gas- tric surgery, 10.83%（17/157） in patients undergoing herniorrhaphy, 11.89% （17/143） in patients undergoing biliary tract surgery, 8.82% （9/102） in patients undergoing eolorectal surgery, 8.82% （9/102） in patients undergoing small in- testinal surgery, and 41.18% （14/34） in patients undergoing pancreatic surgery. Seventy-four strains of pathogenic bac- eria were isolated from infected surgical sites, including 44 strains of Gram-negative bacteria （59.46%）, 27 strains of Gram-positive bacteria （36.49 % ） and 3 strains of fungi （4.05% ）. Gram-negative bacteria included 18 strains of Pseudomonas aeruginosa, 12 strains of Acinetobacter baumannii, 6 strains of Escherichia coli, and 8 strains of other Gram nega- tive bacteria. Gram-positive bacteria included 13 strains of Staphylococcus aureus, 5 strains of Enterococcus, 3 strains of S. epidermidis, and 6 strains of other Gram-positive bacteria. Fungi included 3 strains of Candida albicans. The resistance of P. aeruginosa to cefazolin was 50.00%, its resistance to ciprofloxacin was 72.22%, its resistance to ampicillin was 72. 22%, its resistance to amikacin was 22.22%, and its resistance to gentamicin was 44.44%. The resistance of S. aureus to cefazolin was 46.15%, its resistance to eiprofloxaein was 38. 46%, its resistance to ampicillin was 23.08%, its resist- ance to amikacin was 38.46%, and its resistance to gentamicin was 30. 77%. The rate of infection in patients age 60 or older （10.51%） differed significantly （X2=10. 0678, P〈0.05） from that in patients under the age of 60 （6.20%）. The rate of infection in patients with diabetes （11.04 %） differed significantly （9（2 = 20. 8444, P〈0.05） from that in patients without diabetes （4.92%）. The rate of infection in patients hospitalized for 1 month or longer （12.10% ） differed signifi- cantly （3（2=28. 6044, P〈0.05） from that in patients hospitalized for less than 1 month （4.86%）. The rate of infection in patients with an operating time 〉2 h （12.72% ） differed significantly from that in patients with an operating time ≤2h （5. 06%）. The rate of infection did not differ significantly （P〉0.05） in patients of different genders or in patients with different sizes of surgical wounds （P〉0.05）. Age, diabetes, the duration of hospitalization, and operating time were fac- tors for surgical site infections in patients in General Surgery. Conclusion The pathogenic bacteria causing a surgical site infection in patients in General Surgery were predominantly Gram-negative bacteria, and infections were most preva- lent in patients undergoing type Ⅲ surgery. The predominant pathogenic bacteria were resistant to commonly used antibi- otics. Age, also having diabetes, the duration of hospitalization, and operating time were factors for a surgical site infec- tion in patients in General Surgery.