脊柱外科手术患者医院感染特征及危险因素分析

Characteristics and risk factors of nosocomial infections after spine surgery

目的探讨脊柱外科手术后发生医院感染的相关危险因素及病原菌分布特征,为制定医院感染预防和控制措施提供依据。方法对2014年1~12月1525例脊柱外科手术I类切口患者的临床资料进行统计,分析发生医院感染的易感因素,采用列联χ~2检验和多因素Logistic回归分析。结果 1525例手术患者中,发生医院感染56例(3.67%)。单因素分析显示,患者合并糖尿病、术前住院时间长、风险分级、麻醉分级、手术时间、术中失血量、输血、材料置入、全身麻醉与脊柱手术后发生医院感染有关;多因素Logistic回归分析结果显示,合并糖尿病(OR=4.119,95%CI:1.275~11.125)、手术时间(OR=4.906,95%CI:1.826~22.775)、术中失血量(OR=2.158,95%CI:1.567~7.552)及有植入物(OR=7.519,95%CI:4.714~32.202)是脊柱手术患者术后发生医院感染的独立危险因素。从感染患者标本中共分离出致病菌58株,其中革兰阴性杆菌40株(68.97%),革兰阳性球菌18株(31.03%);医院感染致病菌前3位分别为大肠埃希菌14株(24.14%)、鲍曼不动杆菌11株(18.97%)及金黄色葡萄球菌9株(15.52%)。结论脊柱外科手术患者医院感染危险因素较多,应采取综合防控措施才能有效降低医院感染的发生率,提升医疗质量。

Objective To explore the risk factors and pathogen distributions of nosocomial infections after spinal surgery,and to provide references for its prevention and control.Methods Clinical data (incision I) from January to December 2014 were reviewed to identify the potential risk factors of nosocomial infections.Chi-square test and multivariate logistic regression model were used for the analysis.Results A total of 56 cases (3.67%) were identified as nosocomial infections in 1525 cases.Univariate analysis revealed that diabetes,long preoperative hospital stay,risk classification,anesthesia classification,operation time,intraoperative blood loss,blood transfusion,material implantation and general anesthesia were associated with nosocomial infections after spinal surgery.Multivariate logistic regression analysis identified that diabetes (OR=4.119,95% CI:1.275-11.125),operation time (OR=4.906,95% CI:1.826-22.775),intraoperative blood loss (OR=2.158,95% CI:1.567-7.552),and implants (OR=7.519,95% CI:4.714-32.202) were independent risk factors of nosocomial infections.All 58 strains of pathogenic bacteria were isolated from the samples,including 40 gram-negative bacilli (68.97%) and 18 gram-positive bacilli (31.03%).Top 3 pathogens:14 escherichia coli (24.14%),11 acinetobacter baumannii (18.97%),9 staphylococcus (15.52%).Conclusions Many risk factors of nosocomial infections are observed.Comprehensive prevention and control should be emphasized to effectively reduce the incidence.