急性胆囊炎术后医院感染病原菌及影响因素

Etiological characteristics and influencing factors for postoperative nosocomial infections in patients with acute cholecystitis

目的研究急性胆囊炎患者术后医院感染的影响因素,并分析其病原菌特点。方法选择2015年2月-2018年7月在华中科技大学医院住院的473例急性胆囊炎手术患者,分为两组:术后医院感染39例为感染组,未发生医院感染434例为对照组,记录两组患者各指标如年龄、性别、体质量指数(BMI)、发病时间、选择手术方式和有无合并糖尿病、胆囊结石、幽门螺杆菌(Hp)感染基础疾病等,采用Logistic回归分析急性胆囊炎术后医院感染的影响因素,并分析其病原学特点。结果本研究结果显示年龄、BMI、发病时间、手术方式及合并糖尿病、胆囊结石、Hp感染与急性胆囊炎术后医院感染具有相关性(P<0.05);年龄、高BMI、发病时间、手术方式及糖尿病、胆囊结石、Hp感染是急性胆囊炎术后医院感染的独立危险因素(P<0.05)。39例术后感染的标本中分离出病原菌52株,其中革兰阴性菌最常见,共36株占69.23%,革兰阳性菌13株占25.00%。结论急性胆囊炎术后医院感染以革兰阴性菌最常见,且年龄、基础疾病、BMI、开腹手术、发病时间长及合并胆囊结石、Hp感染是导致医院感染的危险因素,对老年,高BMI且合并糖尿病、胆囊结石Hp感染的患者需要早期诊断、早期手术,减少术后感染的发生。

OBJECTIVE To explore the influencing factors for postoperative nosocomial infections in the patients with acute cholecystitis and analyze the etiological characteristics.METHODS A total of 476 patients with acute cholecystitis who were hospitalized in Huazhong University of Science and Technology Hospital from Feb.2015 to Jul 2018 were retrospectively analyzed,the enrolled patients were divided into two groups,the patients who had postoperative nosocomial infections were assigned as the infection group,and the patients who did not have nosocomial infections were set as the control group.The age,gender,body mass index(BMI),onset time,mode of surgery and complication with underlying diseases such as diabetes mellitus,gallstone and Helicobacter pylori infection were recorded,logistic regression analysis was performed for the influencing factors for the postoperative nosocomial infections in the patients with acute cholecystitis and the etiological characteristics were analyzed.RESULTS The result showed that the postoperative nosocomial infection in the patients with acute cholecystitis was associated with age,BMI,onset time,mode of surgery,complication with diabetes mellitus,gallstone and H.pylori infection(P<0.05).The age,high BMI,onset time,surgery mode,diabetes mellitus,gallstone and H.pylori infection were the independent risk factors for the postoperative nosocomial infection in the patients with acute cholecystitis(P<0.05).Totally 52 strains of pathogens were isolated from the specimens of 39 patients with postoperative infection,36(69.23%)of which were gram-negative bacteria,and 13(25.00%)were gram-positive bacteria.CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the postoperative nosocomial infections in the patients with acute cholecystitis.The age,underlying diseases,BMI,laparotomy,long onset time,complication with gallstone and H.pylori infection are the risk factors for the nosocomial infections.It is necessary to conduct the early diagnosis and early surgery for the patients with old age,high BMI,diabetes mellitus,gallstone and H.pylori infection so as to reduce the incidence of postoperative infections.