多重耐药菌感染与阑尾切除术切口感染相关性巢式病例对照研究

Correlation between multidrug-resistant bacterial infection and incision infection after appendectomy: a nested case-control study

目的分析多重耐药菌(multiple resistant bacteria,MDROs)感染与小儿急性化脓性阑尾炎阑尾切除术切口感染的相关性。方法以2015年1月至2021年1月在贵州医科大学第三附属医院行阑尾切除术治疗的1942例急性化脓性阑尾炎患儿为研究队列,将其中发生切口感染的137例患儿作为观察组,男91例,女46例,年龄中位数为8岁,年龄的四分位数间距为(6,10)岁,年龄范围为1~14岁。巢式病例对照研究设计按照1∶4随机数字表法匹配选取548例未发生切口感染患儿作为对照组,男346例,女202例,中位年龄7岁,年龄的四分位数间距为(5,10)岁,年龄范围为1~14岁。运用单因素与多因素Logistic回归对两组进行比较。结果观察组与对照组MDROs感染率分别为35.77%与22.26%,观察组MDROs感染率大于对照组,差异有统计学意义(P<0.05)。切口感染发生风险与手术时间正相关(OR=2.282,95%CI:1.472~3.648,P=0.001),与手术方式(腹腔镜下阑尾切除术)负相关(OR=0.427,95%CI:0.280~0.561,P=0.000)。结论MDROs感染是小儿急性化脓性阑尾炎阑尾切除术切口感染的危险因素,采用腹镜下手术、缩短手术时间可减少阑尾切除术切口感染发生率。

Objective To explore the correlation between multiple resistant bacteria(MDROs)infection and appendectomic incision infection in children with acute suppurative appendicitis.Methods From January 2015 to January 2021,a total of 1942 children with acute suppurative appendicitis undergoing appendectomy were selected as research group while 137 children with incision infection as observation group.There were 91 boys and 46 girls with a median age of 8(1-14)years and an interquartile range of(6,10)years.The nested case-control study was designed according to the 1∶4 random number table.Another 548 children without incision infection were assigned as control group.There were 346 boys and 202 girls with a median age of 7(1-14)years and an interquartile range of age of(5,10)years.Univariate and multivariate Logistic regressions were utilized for comparing two groups.Results The infection rates of MDROs in observation and control groups were 35.77%and 22.26%respectively.And MDROs infection rate was higher in observation group than that in control group(P<0.05).The risk of incision infection was correlated positively with operative duration(OR=2.282,95%CI:1.472-3.648,P=0.001)and negatively with surgical approach(laparoscopic appendectomy)(OR=0.427,95%CI:0.280-0.561,P=0.000).Conclusion MDROs infection is a risk factor for appendectomic incision infection.Using laparoscopy and shortening operative duration may lower the incidence of appendectomic incision infection in children with acute suppurative appendicitis.