围手术期患者医院感染的病原学特点与影响因素分析

Etiological characteristics and influencing factors of nosocomial infections in perioperative patients

目的探讨围手术期患者医院感染的病原菌分布特点及导致围手术期医院感染的相关因素,为临床防治提供一定的依据。方法选择2013年6月-2015年2月于医院行手术治疗的患者780例,对发生围手术期医院感染的患者进行病原菌鉴定,分析病原菌特点,统计分析患者的年龄、性别、住院时间、术前使用抗菌药物、相关侵入性操作等资料进行单因素分析,根据单因素分析结果进行多因素Logistic分析。结果 780例行手术治疗的患者中有110例发生围手术期感染,感染发生率为14.10%;110例围手术期感染患者医院感染的部位以下呼吸道感染36例占32.73%为主;110例围手术期医院感染患者中共检出病原菌92株,其中革兰阴性菌27株占29.35%、革兰阳性菌56株占60.87%、真菌9株占9.78%;Logistic多元回归分析结果显示,患者年龄≥60岁、存在易感因素、意识障碍及血清白蛋白<28g/L是导致围手术期患者医院感染的影响因素。结论临床医护工作者根据围手术期患者医院感染的病原菌特点及相关影响因素,采取针对性的预防措施,这是降低医院围手术期医院感染的关键。

OBJECTIVE To investigate the distribution characteristics of pathogens of nosocomial infections in perioperative patients and explore the risk factors of nosocomial infections during perioperative period so as to provide some evidences for clinical prevention and treatment.METHODS From Jun.2013 to Feb.2015,780 patients undergoing surgical treatment in the hospital were selected for pathogen detection in patients with perioperative nosocomial infections.The patients＇ age,gender,length of stay,and preoperative use of antibiotics and related invasive operation were recorded for univariate analysis,and the results of univariate analysis were used for multivariable logistic analysis.RESULTS A total of 110 cases of perioperative infections were found in 780 patients undergoing surgical treatment,and the infection rate was 14.10%.There were 36 cases of lower respiratory tract infection among 110 cases of perioperative infection,accounting for 32.73%.A total of 92 strains of pathogenic bacteria were detected from 110 cases of perioperative infection,including 27 strains of gram-negative bacteria accounting for29.35%,56 strains of gram-positive bacteria accounting for 60.87%,and 9 strains of fungi accounting for 9.78%.Multivariable logistic regression analysis showed that age≥60 years old,existence of susceptibility factors,disturbance of consciousness and serum albumin 28 g/L were the main factors affecting nosocomial infections in perioperative patients.CONCLUSION Clinicians should take targeted preventive measures based on etiological characteristics and related factors of nosocomial infections in perioperative patients,which is the key to reduce the rate of perioperative nosocomial infections.