某院骨科脊柱手术后医院感染危险因素分析

Analysis on the risk factors of the nosocomial infections after spinal surgery in department of orthopedics

目的分析骨科脊柱手术医院感染的危险因素并探讨其预防控制措施。方法选择2015年1月-2017年10月某医院骨科脊柱手术的291例患者作为研究对象,对术后医院感染发生情况、感染部位、病原菌分布及相关危险因素进行调查分析。结果共有27例患者发生术后医院感染,感染率为9. 28%;手术部位和呼吸系统是最常见的感染部位,构成比分别占37. 04%和33. 33%;检出32株病原菌中革兰阴性菌占53. 13%、革兰阳性菌占43. 75%、真菌占3. 12%,大肠埃希菌、表皮葡萄球菌为主要病原菌,构成比为28. 13%和21. 88%。年龄较大、手术时间较长、抗菌药物应用种类较多、未经验性应用抗菌药物、有置入物、住院时间较长、合并糖尿病和吸烟患者的术后感染危险性较高。骨科脊柱手术患者术后医院感染的独立危险因素为手术时间、抗菌药物应用种类、经验性应用抗菌药物、住院时间和合并糖尿病等。结论骨科脊柱手术医院感染的危险因素较多,应进行全面评估,制定行之有效的防控措施降低医院感染。

Objective To analyze the risk factors of the nosocomial infections after spinal surgery in department of orthopedics and to discuss the measures for its prevention and control.Methods 291 cases treated with spinal surgery in department of orthopedics from January of 2015 to October of 2017 were selected as the research subjects.The incidence of nosocomial infections,the infected sites,the distribution of pathogenic bacteria and the related risk factors were analyzed.Results 27 patients were with the postoperative nosocomial infections,and the infection rate was 9.28%.The most common infection sites were the surgical site and the respiratory system,and the constituent ratios were 37.04% and 33.33%respectively.In 32 stains of pathogenic bacteria detected,the Gram-negative bacteria,the Gram-positive bacteria and the fungi accounted for 53.13%,43.75% and 3.12% respectively.Escherichia coli and Staphylococcus epidermidis were the main pathogenic bacteria of which the constituent ratios were 28.13% and 21.88% respectively.The risk of the patients with older age,longer operation time,more application of antibiotics,absence of empirical application of antibiotics,application of implants,longer duration of hospitalization,complication of diabetes and smoking were higher.The operative time,the antibacterial application types,the empirical application of antibacterial agents,the duration of hospitalization and the application of diabetes mellitus were the independent risk factors of the incidence of nosocomial infections after spinal surgery in department of orthopedics.Conclusion There are many risk factors correlated with nosocomial infections after spinal surgery in department of orthopedics.The comprehensive assessment should be employed and effective interventions for prevention and control should be formulated to reduce the nosocomial infections.