胃癌术后感染病原菌及危险因素分析

Pathogens isolated from gastric cancer patients with postoperative infection and risk factors

目的分析胃癌根治术后感染病原菌特点及其危险因素。方法选择2016年11月-2019年11月信阳市中心医院收治的胃癌手术患者为研究对象,65例术后感染患者为感染组,65例未感染患者为对照组,自拟回顾性流行病学调查表,收集患者年龄、性别、居住地、病史、吸烟状况、病理类型、手术类型、病原菌培养、炎症因子、病程等信息。分析病原菌特点及感染危险因素。结果感染组65例共检出86株病原菌,其中革兰阴性菌占58.14%,革兰阳性菌占37.21%,真菌4.65%。菌种前三位为肺炎克雷伯菌27株、金黄色葡萄球菌21株、铜绿假单胞菌15株,分别占31.40%、24.42%和17.44%。影响胃癌术后感染的单因素分析结果,年龄≥65岁、BMI≥24.0 kg/m^2、农村居住、吸烟史、2型糖尿病、幽门螺杆菌感染、白蛋白<30.0 g/L、住院时间≥20 d等因素两组间比较有统计学意义(P<0.05)。Logistic回归分析,术前血清白蛋白、手术方式、住院天数等胃癌术后感染的OR值>1(P<0.05)。结论胃癌患者术后感染的主要病原菌为肺炎克雷伯菌、金黄色葡萄球菌和铜绿假单胞菌。胃癌患者手术后感染的因素多,术前血清白蛋白、手术方式、住院天数等是胃癌术后感染的独立危险因素。

OBJECTIVE To investigate the characteristics of pathogens isolated from gastrectomy patients with postoperative infection and analyze the risk factors. METHODS The gastrectomy patients who were treated in Xinyang Center Hospital from Nov 2016 to Nov 2019 were recruited as the study objects, 65 patients who had postoperative infection were assigned as the infection group, and 65 patients who did not have infection were set as the control group. A retrospective epidemiological questionnaire was designed to collect the data of the patients, including age, gender, place of residence, medical history, smoking status, pathological types, types of surgery, culture of pathogens, inflammatory factors and course of disease. The characteristics of pathogens and risk factors for the infection were observed. RESULTS A total of 86 strains of pathogens were isolated from 65 patients in the infection group, 58.14% of which were gram-negative bacteria, 37.21% were gram-positive bacteria, and 4.65% were fungi. Klebsiella pneumoniae(27 strains), Staphylococcus aureus(21 strains) and Pseudomonas aeruginosa(15 strains) ranked the top 3 species of pathogens, accounting for 31.40%, 24.42% and 17.44%, respectively. Univariate analysis showed that the no less than 65 years of age, BMI no less than 24.0 kg/m^2, residence in rural area, smoking history, type 2 diabetes mellitus, Helicobacter pylori infection, albumin less than 30.0 g/L and length of hospital stay no less than 20 days were the influencing factors for the postoperative infection in the gastric cancer patients, and there were significant differences between the two groups(P<0.05). Logistic regression analysis indicated that OR values of the preoperative albumin, surgeral mode and the length of hospital stay were more than 1(P<0.05). CONCLUSION K.pneumoniae, S.aureus and P.aeruginosa are dominant among the pathogens causing the postoperative infection in the gastric cancer patients. There are a variety of influencing factors for the postoperative infection;the preoperative albumin, surgeral mode and the length of hospital stay are the independent risk factors for the postoperative infection in the gastric cancer patients.