284例胃肠手术患者切口感染病原菌分布特征以及血清PCT、hs-CRP、IL-6、IL-2水平变化分析

Analysis of Pathogens’ Distribution and Changes of PCT, hs-CRP, IL-6 and IL-2 in 284 Patients with Postoperative Incision Infection after Gastrointestinal Surgery

目的:分析胃肠手术患者术后切口感染的病原菌分布特征及血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-2(IL-2)水平变化对感染的影响。方法:抽取医院2018年1月—2019年12月收治的行胃肠手术患者284例临床资料,依据手术切口感染情况分为感染组(n=29)和未感染组(n=255);分析与比较其术后48 h时切口组织液中感染病原菌的特征以及PCT、hs-CRP、IL-6、IL-2水平变化对术后切口感染的预测效能。结果:284例胃肠手术患者标本中,分离出病原菌株43株,其中革兰阴性菌21株(占48.84%,以铜绿假单胞菌为主)、革兰阳性菌17株(占39.53%,以金黄色葡萄球菌为主)和真菌5株(占11.63%);术后48 h时,感染组患者PCT、hs-CRP、IL-6、IL-2水平值显著高于未感染组(P<0.05);上述指标采用ROC曲线预测切口感染的AUC分别为0.836、0.788、0.925和0.780,特异度分别为79.31%、58.62%、89.66%和65.52%。结论:引起胃肠疾病患者术后切口感染的病原菌呈现多样化分布,且通过早期炎症因子水平的预测可有效判别其切口感染的发生概率,术后感染风险不容小觑,临床应高度重视。

Objective: To analyze the characteristics of pathogen distribution of postoperative incision infection in patients undergoing gastrointestinal surgery and the influence of serum PCT, hypersensitive C-reactive protein(hsCRP), interleukin-6(IL-6) and interleukin-2(IL-2) levels on infection. Methods: Clinical data of 284 patients undergoing gastrointestinal surgery admitted to our hospital from January 2018 to December 2019 were selected and divided into infected group(n=29) and uninfected group(n=255) based on the infection status of surgical incision. The characteristics of pathogenic bacteria in the tissue fluid of incision at 48 h after operation were analyzed and compared, and the prediction efficacy of the changes in the levels of PCT, hs-CRP, IL-6 and IL-2 on postoperative incision infection were compared. Results: 43 strains of pathogenic bacteria were isolated from 284 gastrointestinal surgery patients, among whom 21 strains of Gram-negative bacteria(mainly Pseudomonas aeruginosa) accounted for 48.84%, 17 strains of Gram-positive bacteria(mainly Staphylococcus aureus) accounted for 39.53%, and 5 strains of fungi accounted for11.63%. At 48 h after operation, the levels of PCT, hs-CRP, IL-6 and IL-2 in infected group were significantly higher than those in uninfected group(P< 0.05). The AUC of the above indexes used ROC curve to predict incision infection were 0.836, 0.788, 0.925 and 0.780, respectively, and the specificity was 79.31%, 58.62%, 89.66% and 65.52%, respectively. Conclusion: Pathogenic bacteria causing postoperative incision infection in patients with gastrointestinal diseases present diversified distribution, and the prediction of the level of early inflammatory factors can effectively distinguish the incidence probability of incision infection, so the risk of postoperative infection should not be underestimated,and special attention should be paid to it.