单中心新生儿外科手术部位感染危险因素分析

Risk factors analysis of neonatal surgical site infection:single center experience

目的探讨单中心新生儿外科手术部位感染(neonatal surgical site infections,NSSI)的可能危险因素以及感染菌源谱及敏感药物的应用。方法收集上海交通大学医学院附属新华医院小儿外科自2009年1月至2019年1月行新生儿期外科手术患儿的临床资料。按有无发生切口部位感染,将患儿分为感染组和非感染组,对比分析两组患儿分娩方式、有无早产、性别、出生体重、手术时间、住院时间、手术切口类型等可能相关的危险因素。按发生感染的伤口类型不同,对比分析不同类型患儿发生率。所有NSSI病例常规行伤口脓液培养及细菌药敏试验,搜集相关信息,对NSSI感染菌源谱和敏感药物进行分析。结果10年期间共收治新生儿外科手术患儿1133例。其中,男654例,女479例;平均年龄4.12 d。其中有42例(3.7%)发生NSSI(感染组),伤口感染临床表现时间5.8 d(范围2~13 d),住院平均时间41.9d(范围18~180 d),早产低体重儿感染4例(0.35%)。NSSI与性别、出生体重、分娩方式无关,而与伤口类型明显有关(P=0.001)。NSSI病儿伤口脓液培养以革兰氏阴性菌为主,其中肺炎克雷伯菌、鲍曼不动杆菌及大肠埃希菌居多,分别为16例(35%)、11例(24%)和10例(22%)。革兰氏阳性菌则以屎肠球菌、溶血性葡萄球菌和粪肠球菌多见,分别为9例(47%)、4例(21%)和3例(16%)。革兰氏阴性菌的敏感药物以阿米卡星35例(83%)、妥布霉素25例(60%)和庆大霉素25例(60%)多见,而革兰氏阳性菌则以利奈唑胺17例(89%)、万古霉素16例(84%)和替加环素12例(63%)多见。结论伤口类型是NSSI相关危险因素,特别是胃肠造口手术部位。感染部位脓液培养结果均呈阳性,以革兰氏阴性菌居多。

Objective To explore the possible risk factors of neonatal surgical site infections(NSSI),the bacterial source spectrum and the use of sensitive drugs at a single center.Methods Clinical data were retrospectively analyzed for 1133 neonates undergoing operation from January 2009 to January 2019.According to the occurrence of incision site infection,they were divided into infection and non-infection groups.The possible risk factors such as delivery mode,prematurity,gender,birth weight,operative duration,length of hospital stay,type of surgical incision and other possible risk factors were compared between two groups.And the incidence of different types of wound infection was compared.Pus culture and bacterial drug sensitivity test were performed routinely in all NSSI cases and the relevant information was collected.The bacterial source spectrum and sensitive drugs of NSSI infection were analyzed.Results A total of 1133 surgical neonates were admitted.There were 654 boys and 479 girls with an average age of 4.12 days.And 42 cases(3.7%)had NSSI(infection group).The average onset time of wound infection was 5.8(2-13)days and the average length of hospital stay was 41.9(18-180)days.Four cases of premature low-birth-weight infants were infected(0.35%).NSSI had no correlation with gender,birth weight or delivery mode.However,it was obviously correlated with wound type(P=0.001).Gram-negative bacteria were the predominant pathogens in wound pus culture of NSSI.Klebsiella pneumoniae,Acinetobacter baumannii and Escherichia coli accounted for 16(35%),11(24%)and 10(22%)respectively.Enterococcus faecium(n=9,47%),Staphylococcus haemolyticus(n=4,21%)and Enterococcus faecalis(n=3,16%)were the most common Gram-positive bacteria.Amikacin,tobramycin and gentamicin were the most sensitive agent for Gram-negative bacteria while linezolid,vancomycin and tigecycline were the most common for Gram-positive bacteria.Conclusions Wound type is a related risk factor,especially at site of gastrostomy.The results of pus culture of infected sites are all positive and Gram-negative bacteria are the most common bacteria.