妇产科术后医院感染患者的临床特点和病原菌分布及影响因素分析

Analysis of clinical characteristics,pathogens distribution and risk factors of postoperative nosocomial infections in obstetrics and gynecology department

目的探讨妇产科术后感染临床特点、病原菌分布及影响因素分析。方法选择2013年1月-2016年12月于医院妇科、产科行手术的患者573例;采集患者感染部位标本,分离培养病原菌及耐药性试验;调查患者的年龄、体重指数、手术时间、术中出血量、合并基础疾病、术后留置导尿管等临床资料。采用单因素和多因素分析影响术后医院感染的相关影响因素。结果 573例妇产科手术患者中有31例发生术后医院感染,医院感染发生率为5.41%,以呼吸系统感染13例占41.94%为主;31例术后医院感染患者中分离培养病原菌51株,其中革兰阴性杆菌28株占54.90%、革兰阳性球菌21株占41.18%、真菌2株占3.92%;铜绿假单胞菌对阿米卡星和头孢西丁耐药率较高,均>70%,大肠埃希菌对环丙沙星和头孢曲松耐药率较高,均>80%;主要革兰阳性菌对青霉素G和红霉素耐药率均为100.00%;多元Logistic回归分析结果显示,体重指数≥25kg/cm2、手术时间≥90 min、术后留置导尿管、侵入性操作及术前使用抗菌药物为妇产科术后医院感染的影响因素。结论妇产科术后医院感染发生率较高,以革兰阴性杆菌和革兰阳性球菌为主,术后医院感染影响因素较多,应针对感染影响因素采取相应的预防措施,避免术后医院感染的发生。

OBJECTIVE To investigate the clinical characteristics,pathogens distribution and risk factors of postoperative infections in obstetrics and gynecology department.METHODS A total of 573 cases of patients with gynecological and obstetrical operations from Jan.2013 to Dec.2016 were collected.Specimens collected from patients with infections were used for isolation of pathogenic bacteria and drug resistance test.The patients＇ data,including age,body mass index,operation time,intraoperative blood loss,underlying diseases,postoperative indwelling catheter,were investigated.Risk factors of nosocomial infections after operation were analyzed by univariate analysis and multivariable analysis.RESULTS Totally 31 cases of nosocomial infections occurred among 573 cases of patients with obstetrics and gynecology surgery,and the infection rate was 5.41%,which were mainly 13 cases of respiratory system infections,accounting for 41.94%.Totally 51 strains of pathogens were isolated from 31 cases of patients with postoperative nosocomial infections,including 28 strains of gram-negative bacteria accounting for 54.90%,21 strains of gram-positive bacteria accounting for 41.18%,and 2 strains of fungi accounting for 3.92%.Pseudomonas aeruginosa had high resistant rates to amikacin and cefoxitin,which were both higher than 70%.Escherichia coli had high resistant rates to ciprofloxacin and ceftriaxone,which were both higher than 80%.The resistant rates of main gram-positive bacteria to penicillin G and erythromycin were 100%.Multivariable logistic regression analysis showed that body mass index ≥25 kg/cm^2,operation time ≥90 min,indwelling catheter,invasive operation and preoperative use of antimicrobial agents were the risk factors for nosocomial infection after gynecological surgery.CONCLUSIONThe gynecological postoperative infection rate is high,and the main pathogens are gram-negative bacilli and gram-positive cocci.There are many risk factors for postoperative nosocomial infection,so we should take corresponding preventive measures according to the risk factors of infection,so as to avoid postoperative nosocomial infection.