结肠癌合并肠梗阻术后伤口感染的病原学及影响因素分析

Pathogen and Influencing Factors of Postoperative Wound Infection in Patients with Colon Cancer Combined with Intestinal Obstruction

目的探讨结肠癌合并肠梗阻患者术后伤口感染的病原学及影响因素。方法选择结肠癌合并肠梗阻患者144例,所有患者都给予手术治疗,术后14 d内进行伤口分泌物标本采集,判断伤口感染情况,并进行病原学、耐药性分析,同时进行影响因素的调查分析。结果在144例患者中,术后发生伤口感染8例,感染率为5. 6%。伤口感染8例患者共分离出12株病原菌,其中革兰阴性菌8株,革兰阳性菌4株。大肠埃希菌对氨苄西林、环丙沙星、复方新诺明都有比较高的耐药性,金黄色葡萄球菌对氨苄西林、环丙沙星、左氧氟沙星也有比较高的耐药性。单因素分析结果表明:导致结肠癌合并肠梗阻患者术后伤口感染显著性相关的因素有体重指数、合并糖尿病、术前化疗、手术时间、术前低蛋白、术后引流管放置时间等(P <0. 05)。logistic非条件回归分析结果显示:合并糖尿病、术前化疗、术前低蛋白、手术时间是引起患者术后伤口感染发生的独立危险因素(P <0. 05)。结论结肠癌合并肠梗阻患者术后伤口感染比较常见,病原菌多为革兰阴性菌,对氨苄西林、环丙沙星、复方新诺明具有比较高的耐药率,合并糖尿病、术前化疗、术前低蛋白、手术时间是导致术后伤口感染的主要因素。

Objective To investigate the pathogen and influencing factors of postoperative wound infection in patients with colon cancer combined with intestinal obstruction.Methods Used a retrospective study,from August 2013 to February 2017,144 patients of colon cancer combined with intestinal obstruction in our hospital for diagnosis and treatment were selected as the research object,all the patients were given surgery,and the postoperative 14d wound secretion samples were collected for wound infection judgment,and analyzed the etiology,drug resistance,and influencing factors.Results There were 8 patients wound infection in the 144 patients,and the infection rate was 5.6%.A total of 12 strains of pathogenic bacteria were isolated from 8 patients of wound infection that included 8 strains of gram negative bacteria and 4 strains of gram positive bacteria.Escherichia coli was relatively high resistance to ampicillin,ciprofloxacin,bactrim,Staphylococcus aureus was also relatively high resistance to ampicillin,ciprofloxacin,levofloxacin.The results of univariate analysis showed that the cause of wound infection were significantly associated with BMI,diabetes,preoperative chemotherapy,operation time,preoperative low protein,postoperative drainage time(P<0.05).Logistic regression analysis showed that diabetes,preoperative chemotherapy,preoperative low protein and operation time were independent risk factors for postoperative wound infection(P<0.05).Conclusion The postoperative wound infection in the colon cancer combined with intestinal obstruction patients is common,pathogenic bacteria are more with gram negative bacteria that have relatively high rate of resistance to ampicillin,ciprofloxacin,bactrim,diabetes,preoperative chemotherapy,preoperative low protein and operation time were the main factors leading to postoperative wound infection.