颅脑损伤开颅术后医院感染病原学及预测模型

Etiological characteristics of postoperative nosocomial infection in craniocerebral injury patients undergoing craniotomy and prediction model

目的 探讨颅脑损伤开颅患者术后医院感染病原学及预测模型。方法 选择2017年7月-2021年5月河南省中医院诊治的324例颅脑损伤患者为研究对象,统计术后医院感染发生率及感染病原菌分布,多因素Logistic回归分析颅脑损伤术后医院感染的危险因素并构建感染预测模型,采用受试者工作特征(ROC)曲线评估模型预测效果。结果 324例颅脑损伤患者共29例发生术后医院感染,发生率为8.95%;感染发生时间集中分布于术后2周内,占72.41%;最常见的感染部位为下呼吸道,占41.38%;29例患者送检标本中共培养出病原菌51株,其中革兰阴性菌36株占70.59%,革兰阳性菌13株占25.49%和真菌2株占3.92%;多因素Logistic回归模型结果显示:年龄≥60岁、昏迷程度、侵入性操作、再次手术、合并糖尿病及术后低蛋白血症是术后医院感染发生的危险因素(P<0.05);构建的感染预测模型ROC曲线下面积(AUC)为0.822。结论 颅脑损伤患者术后医院感染发生率为8.95%,多见于术后1~2周,感染部位以下呼吸道为主,感染病原菌以革兰阴性菌为主;年龄≥60岁、昏迷程度、侵入性操作、再次手术、合并糖尿病以及术后低蛋白血症均是术后医院感染发生的危险因素,以上述因素为基础构建的预测模型对于颅脑损伤患者术后医院感染风险预测具有重要指导作用。

OBJECTIVE To explore etiological characteristics of postoperative nosocomial infection in craniocerebral injury patients undergoing craniotomy and prediction model.METHODS A total of 324 patients with craniocerebral injury who were treated in Henan Hospital of Traditional Chinese Medicine from Jul 2017 to May 2021 were recruited as the study subjects.The incidence of postoperative nosocomial infection and distribution of pathogens were statistically analyzed.Multivariate logistic regression analysis was performed for risk factors for the postoperative nosocomial infection,the prediction model for infection was established,and the predictive effect of the model was evaluated by ROC curves.RESULTS Totally 29 patients had postoperative nosocomial infection among the 324 patients with craniocerebral injury,with the incidence rate 8.95%.The patients who had the infection within 2 weeks after the surgery accounted for 72.41%.Lower respiratory tract was the most common infection site,accounting for 41.38%.Totally 51 strains of pathogens were isolated from submitted specimens of the 29 patients,36(70.59%) of which were gram-negative bacteria,13(25.49%) were gram-positive bacteria,and 2(3.92%) were fungi.The result of multivariate logistic regression model analysis showed that the no less than 60 years of age,degree of coma,invasive procedure,surgery for second time,complication with diabetes mellitus and postoperative hypoproteinemia were the risk factors for the postoperative nosocomial infection(P<0.05).The area under ROC curve(AUC) of the prediction model was 0.822.CONCLUSION The incidence of postoperative nosocomial infection is 8.95% among the patients with craniocerebral injury,and the infection is commonly seen in 1-2 weeks after surgery.Lower respiratory tract is the major infection site,and the gram-negative bacteria are dominant among the pathogens causing the infection.The no less than 60 years of age,degree of coma,invasive procedure,surgery for second time,complication with diabetes mellitus and postoperative hypoproteinemia are the risk factors for the postoperative nosocomial infection.The prediction model established based on the risk factors may provide guidance for the prediction of postoperative nosocomial infection in the patients with craniocerebral injury.