老年白内障患者人工晶体植入术后医院感染的病原学分析及影响因素探究

Etiological characteristics of postoperative nosocomial infections in elderly cataract patients undergoing intraocular lens implantation and influencing factors

目的详细了解老年白内障患者人工晶体植入术后医院感染的病原学特点及影响因素。方法选择2013年2月-2015年12月在医院行老年白内障人工晶体植入术的患者2672例,采集患者标本对其进行病原学、耐药性分析,同时详细记录患者年龄、性别、体质量指数、手术时间、住院时间、是否存在玻璃体溢出、是否合并贫血、低蛋白血症及是否合并高血压、糖尿病等相关因素进行单因素和多因素Logistics分析。结果 2672例在医院行老年白内障患者人工晶体植入术后共有69例患者发生医院感染,感染率为2.58%。发生例次感染78例,例次感染率为2.92%;78例次老年白内障患者人工晶体植入术后医院感染患者中共检测出病原菌108株,其中主要以革兰阳性为主73株,占67.59%,其次为革兰阴性菌35株,占32.41%;结果显示,表皮葡萄球菌对万古霉素、左氧氟沙星、阿莫西林、阿奇霉素的耐药率较低。而对克林霉素、头孢曲松、头孢呋辛的耐药率>64.29%。粪肠球菌对目前常用抗菌药物的耐药性相对较低,而对克林霉素的耐药率达53.33%;患者年龄≥70岁、手术时间≥10min、透明角膜手术切口、存在玻璃体溢出及合并糖尿病是导致老年白内障患者人工晶体植入术后患者医院感染的独立影响因素(P<0.01)。结论导致老年白内障人工晶体植入术后医院感染的病原菌主要为条件致病菌,因此要依据病原菌和药敏结果的特点选择合理的抗菌药物进行预防和治疗。同时依据引起老年白内障人工晶体植入术后医院感染的相关影响因素采取必要的防控措施。这对于减少感染的发生和提高患者预后有着重大意义,值得临床推广。

OBJECTIVE To understand the etiological characteristics of postoperative nosocomial infection in elderly cataract patients undergoing intraocular lens implantation and analyze the influencing factors.METHODS A total of2672 elderly patients with cataract who underwent the intraocular lens implantation in the hospital from Feb 2013 to Dec 2015 were enrolled in the study,the specimens were collected from the patients,the etiological characteristics were analyzed,the drug resistance rates were observed,and the univariate analysis and multivariate logistic regression analysis were performed for the related factors,including the age,gender,body mass index,operation duration,length of hospital stay,vitreous overflow,anemia,hypoproteinemia,complication with hypertension and diabetes mellitus.RESULTS Of the 2672 elderly patients with cataract who underwent the intraocular lens implantation,69 had postoperative nosocomial infection,with the infection rate 2.58%;totally 78 case-times of patients had the infection,with the case-time infection rate 2.92%.Totally 108 strains of pathogens were isolated from the 78 case-times of patients with postoperative nosocomial infections,73（67.59%）of which were gram-positive bacteria,35（32.41%）were gram-negative bacteria.The result of drug susceptibility testing showed that the drug resistance rates of Staphylococcus epidermidis strains to vancomycin,levofloxacin,amoxacillin and azithromycin were low,while the drug resistance rates to clindamycin,ceftriaxone and cefuroxime were more than64.29%;the drug resistance rate of Enterococcus faecalis strains to the commonly used antibiotics was low,while the drug resistance rate to clindamycin was 53.33%.The independent influencing factors for the postoperative nosocomial infections in the elderly cataract patients included the no less than 70 years of age,operation duration no less than 10 min,transparent corneal incision,vitreous overflow and complication with diabetes mellitus（P〈0.01）.CONCLUSION The opportunistic pathogens are dominant among the pathogens causing the postoperative nosocomial infections in the elderly cataract patients undergoing intraocular lens implantation.It is necessary to reasonably use antibiotics based on the result of drug susceptibility testing and take necessary prevention measures according to the influencing factors for the postoperative nosocomial infections so as to reduce the incidence of the infections and improve the prognosis of the patients,and it is worthy to be promoted in the hospital.