骨科手术患者术后医院感染相关因素分析

Related factors for postoperative nosocomial infection in patients of orthopedics department

目的探讨骨科手术患者术后医院感染的相关因素,为临床提供参考。方法回顾性分析2014年1月-2017年9月于医院行骨科手术患者1 864例的临床资料,记录患者性别、年龄、体重指数、美国麻醉医师协会(ASA)分级、既往史、基础疾病、手术原因、手术部位、手术类型、接台手术、手术时间、切口分类、术中植入物、抗菌药物应用时间、住院时间、侵入性操作、术后入ICU治疗等临床资料,归纳骨科手术患者术后医院感染的相关因素。结果 1 864例患者发生医院感染75例,感染率为4.02%,以切口感染、呼吸道感染和泌尿系感染为主;共培养分离病原菌93株,其中革兰阴性菌62株占66.67%,革兰阳性菌28株占30.11%,真菌3株占3.23%;年龄、侵入性操作、接台手术、手术部位、急诊手术、术后抗菌药物应用时间、植入物是骨科手术患者术后医院感染的相关因素(P<0.05)。结论多种因素均可影响骨科手术患者术后医院感染的发生,临床工作中应对患者术后感染的风险充分评估,并进行针对性干预,以减少骨科手术患者术后医院感染的发生率。

OBJECTIVE To explore the related factors for postoperative nosocomial infection in patients of orthopedics department so as to provide guidance for clinical treatment.METHODS The clinical data of 1 864 patients who receive orthopedic surgery in the hospital from Jan 2014 to Sep 2017 were retrospectively analyzed.The clinical data,including gender,age,body mass index,American Society of Anesthesiologists（ASA）classification,previous history,underlying diseases,reasons of surgery,surgical sites,types of surgery,consecutive surgery,operation duration,types of incision,intraoperative implantation,time of use of antibiotics,length of hospital stay,invasive procedures and postoperative treatment in ICU,were recorded,and the related factors for the postoperative nosocomial infection were summarized.RESULTS Of the 1 864 patients,75 had nosocomial infection,with the infection rate 4.02%;the patients with incision infection,respiratory tract infection and urinary tract infection were dominant.Totally 93 strains of pathogens were isolated,62（66.67%）of which were gram-negative bacteria,28（30.11%）were gram-positive bacteria,and 3（3.23%）were fungi.The related factors for the postoperative nosocomial infection in the patients of orthopedics department included the age,invasive procedures,consecutive surgery,surgical sites,emergency surgery,time of postoperative use of antibiotics and implantation（P〈0.05）.CONCLUSION There are a variety of related factors for the postoperative nosocomial infection in the patients of orthopedics department.It is necessary for the hospital to fully assess the risk of postoperative infection and take targeted intervention measures so as to reduce the incidence of postoperative nosocomial infection.