老年患者结直肠癌术后切口医院感染的危险因素及病原学特点探究

Risk Factors and Pathogen Characteristics of Postoperative Incision Nosocomial Infections in Elderly Patients with Colorectal Cancer

目的:探讨老年患者结直肠癌术后切口医院感染的危险因素以及病原学特点,为临床干预提供依据。方法:回顾性分析2012年1月至2016年12月于我院行手术治疗的结直肠癌患者248例临床资料,分析患者术后切口医院感染率、病原菌分布情况、耐药性,对影响患者出现术后切口感染的危险因素进行Logistic分析,并制定预防措施。结果:248例老年结直肠癌患者发生术后切口医院感染48例,感染率为19.35%。对术后切口发生医院感染的48例患者共检测出病原菌72株,其中革兰阴性菌42株,占58.33%;革兰阳性菌24株,占33.33%;真菌6株,占8.33%。耐药性结果分析显示,大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对头孢哌酮、亚胺培南、阿米卡星等药物的耐药性较高。糖尿病、腹腔镜手术、腹部手术史、术后造瘘、手术持续时间、吸烟、住院时间、导尿管留置时间、急诊手术是导致结肠癌患者出现术后切口医院感染的危险因素,差异有统计学意义(P<0.05);通过Logistic分析,结果表明糖尿病、腹腔镜手术、术后造瘘、手术持续时间、吸烟、住院时间、导尿管留置时间、腹部手术史、急诊手术等危险因素是导致结肠癌患者术后切口医院感染发生的独立危险因素,差异有统计学意义(P<0.05)。结论:老年结直肠癌术后切口医院感染发生率较高,其主要病原菌为大肠埃希菌、肺炎克雷伯菌,糖尿病、腹腔镜手术、术后造瘘、手术持续时间、吸烟、住院时间、导尿管留置时间、腹部手术史等危险因素是导致结肠癌患者术后切口医院感染发生的独立危险因素。

To investigate the risk factors and etiological characteristics of incision nosocomial infections in elderly pa-tients with colorectal cancer after operation, so as to provide evidence for clinical intervention. Methods：The clinical data of 248 patients with colorectal cancer who underwent surgical treatment in our hospital from January-2012 to December 2016 were retrospec-tively analyzed. The incidence of incision nosocomial infection, the distribution of pathogenic bacteria and drug resistance after opera-tion were analyzed. The risk factors affecting the postoperative incision infection were analyzed by Logistic analysis, and the preven-tive measures were made. Results ： Postoperative incision nosocomial infection occurred in 48 out of 248 elderly patients with color-ectal cancer, with an infection rate of 19.35 %. 72 strains of pathogenic bacteria were detected in 48 patients with postoperative inci-sion nosocomial infection, of which 42 were Gram-negative bacteria, accounting for 58.33 % , 24 strains of Gram-positive bacteria, 33.33% and 6 of fungi, accounting for 8.33%. Analysis of drug resistance results showed that Escherichia coli, Klebsiella pneu-moniae, Pseudomonas aeruginosa had higher resistance to cefoperazone, imipenem, urethral amikaza and other drugs. Diabetes, laparoscopy surgery,abdominal operation history, postoperative fistula, duration of surgery, smoking, hospitalization time, urethral catheter indwelling time, emergency operation were the risk factors for the postoperative hospital infection of colon cancer patients （P 〈 0.05）. Through Logistic analysis, the results showed the risk factors such as diabetes, laparoscopic surgery, postoperative fistula, duration of operation, smoking, hospitalization time, indwelling time of urethral catheter, abdominal operation history and e-mergency operation were independent risk factors （ P 〈 0.05 ） for the incidence of postoperative nosocomial infection of colon cancer patients. Conclusion：The incidence of incisional nosocomial infection in elderly patients with coloretal cancer is high. The main pathogens are Eseheriehia coli, Klebsiella pneumoniae, diabetes, laparoscopic surgery, postoperative fistula, operation duration, smoking, hospitalization time, urethral catheter indwelling time, abdominal operation history and other risk factors are independent risk factors leading to postoperative incision nosocomial infection.