骨科清洁手术部位感染病原菌分布与影响因素分析

Analysis on the distribution of pathogens and influencing factors of surgical site infection in orthopedic clean surgery

目的通过对北京某三甲医院骨科清洁手术部位感染情况进行调查,对可能的清洁手术部位感染危险因素进行筛选,找出清洁手术部位感染的独立危险因素。方法回顾性分析北京某三甲医院2010年-2019年骨科清洁手术病例,采用病例对照法研究,将术后发生清洁手术部位感染患者与同期未发生手术部位感染的患者,按1:2频数配比法,匹配因素为手术科室、年份,对清洁手术感染可能的影响因素予以多因素分析。结果2010-2019年骨科共59例清洁手术部位感染病例。感染病例微生物标本送检率为61.0%(36/59),病原体检出率为77.8%(28/36);28例病例共分离到34株病原菌,其中6例病例为混合感染(2种及以上病原菌);病原菌培养结果,革兰氏阳性菌22株(64.7%):其中金黄色葡萄球菌13例(38.2%),表皮葡萄球菌7例(20.6%);革兰氏阴性菌12株(35.3%)。多因素分析后得出,清洁手术部位感染的独立危险因素为糖尿病、术前贫血、手术时间≥180min、术中出血>1000ml、超重和肥胖、心功能Ⅲ级(P<0.05)。结论控制清洁手术部位感染,建议采取如下措施:加强医务人员手卫生管理;术前积极控制各种危险因素,如调整血糖,纠正贫血,针对超重肥胖和心功能差的患者,积极进行术前评估,完善手术计划,对患者进行预防手术部位感染的健康宣教;术者应提高手术技巧,充分止血,缩短手术时间。

Objective To investigate the conditions of surgical site infection(SSI)in orthopedic clean surgery of a certain first-class tertiary hospital in Beijing,to screen for possible risk factors and to identify the independent risk factors for clean incision infection.Methods A retrospective analysis of orthopedic clean surgery cases in a certain firstclass tertiary hospital in Beijing from 2010to 2019was conducted.By using case-control study,the patients infected with a clean incision after surgery were matched with surgical patients with no incisional infection at the same period by 1:2frequency matching with surgery department and year.A logistic regression analysis is carried out on the possible influencing factors of clean incision infection.Results A total of 59cases of clean incision infection were monitored during 2010-2019.The infection specimen submission rate was 61.0%(36/59),and the positive rate was 77.8%(28/36);a total of 34strains of pathogenic bacteria were isolated from 28cases,of which 6cases were mixed infection(2or more pathogens);the results of bacterial culture showed that 22strains were gram positive bacteria(64.7%),including 13cases of Staphylococcus aureus(38.2%),7cases of Staphylococcus epidermidis(20.6%);12strains were gram negative bacteria(35.3%).The analysis of logistic regression method found that the independent risk factors for clean incision infection were diabetes,preoperative anemia,operation time≥180min,intraoperative blood loss>1000ml,overweight and obesity,and cardiac function gradeⅢ(P<0.05).Conclusion The following measures should be taken to control the surgical site infection of clean operation:strengthen the hand hygiene management of medical personnel;actively control various risk factors before surgery,such as adjusting blood glucose,correcting anemia,for overweight or obese patients and patients with poor heart function,actively conducting preoperative evaluation,improving the surgical plan,and carrying out health education on the prevention of surgical site infection for patients;the surgical techniques should be improved so as to stop bleeding sufficiently and shorten the operation time.