妇科手术后切口感染的病原学特征及影响因素分析

Analysis of Etiological Characteristics and Influencing Factors of Incision Infection after Gynecological Operation

目的:分析妇科手术后切口感染的病原学特征及影响因素,以期为临床预防和控制妇科手术后切口感染提供指导。方法:采用回顾性方法,收集2019年1月-2020年12月于南平市人民医院妇科住院手术且发生感染的80例患者资料(感染组),同期进行妇科手术未发生切口感染的资料1 032例患者资料(未感染组),对手术切口送检标本感染的病原学特征及影响因素进行分析。结果:感染组共检出82株病原菌,其中革兰阴性菌株57株,占69.51%,主要为铜绿假单胞菌(24.39%)、大肠埃希菌(24.39%)、肺炎克雷伯菌(15.85%);革兰阳性菌23株,占28.05%,主要为金黄色葡萄球菌(12.94%)、表皮葡萄球菌(9.76%);真菌2株,占2.44%,为光滑假丝酵母菌1株、白色假丝酵母菌1株。铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌对氨苄西林/舒巴坦和亚胺培南敏感。金黄色葡萄球菌对环丙沙星、复方磺胺、氨苄西林/舒巴坦、亚胺培南、万古霉素敏感,表皮葡萄球菌对左氧氟沙星、万古霉素敏感。多因素logistic回归分析显示,年龄、贫血、预防使用抗菌药物是妇科手术后切口感染患者的独立影响因素(P<0.05)。结论:妇科手术后切口感染的病原菌种类较多,影响因素也较多,临床应加强术后感染管理以降低感染率。

Objective:To analyze the etiological characteristics and influencing factors of incision infection after gynecological operations,in order to provide guidance for clinical prevention and control of incision infection in gynecological operations.Method:A retrospective method was used to collect the data of 80 patients (infection group) who underwent gynecological surgery in Nanping People’s Hospital from January 2019 to December 2020 and the data of 1 032 patients (non-infection group) who underwent gynecological surgery without incision infection during the same period.The etiological characteristics and influencing factors of infection in surgical incision specimens were analyzed.Result:A total of 82 pathogenic strains were detected in the infection group,including 57 Gram-negative strains (69.51%),mainly pseudomonas aeruginosa (24.39%),Escherichia coli (24.39%) and Klebsiella pneumoniae (15.85%).There were 23 Gram-positive strains,accounting for 28.05%,mainly staphylococcus aureus (12.94%) and Staphylococcus epidermidis (9.76%).There were 2 strains of fungi,accounting for 2.44%,including 1 strain of Candida glossum and 1 strain of Candida albicans.Pseudomonas aeruginosa,Escherichia coli and Klebsiella pneumoniae were sensitive to Ampicillin/Sulbactam and Pmipenem.Staphylococcus aureus was sensitive to Ciprofloxacin,Cotrimosulfonamide,Ampicillin/Sulbactam,Imipenem and Vancomycin,while Staphylococcus epidermidis was sensitive to Levofloxacin and Vancomycin.Multivariate logistic regression analysis showed that age,anemia and preventive use of antibiotics were independent influencing factors for patients with wound infection after gynecological surgery (P<0.05).Conclusion:There are many kinds of pathogenic bacteria and many influencing factors in the incision infection after gynecological operation,postoperative infection management should be strengthened to reduce the infection rate.