人工耳蜗植入术后皮瓣感染病原学及预测风险模型构建

Etiology of skin flap infection and construction of risk prediction model after cochlear implantation

目的探究人工耳蜗植入术后皮瓣感染病原学,并构建预测风险模型。方法选择2018年8月-2021年8月南京医科大学附属常州第二人民医院收治的82例人工耳蜗植入术后皮瓣感染患者为感染组,统计皮瓣感染患者的病原学特征;并以同期人工耳蜗植入术后未感染者207例为对照组,比较两组患者一般资料,采用多元Logistic回归分析患者术后皮瓣感染的影响因素,并建立风险预测模型,采用Hosmer-Lemeshow检验及受试者工作特征(ROC)曲线评估模型拟合度及对患者术后皮瓣感染的预测价值。结果82例皮瓣感染患者共检出85株病原菌,其中革兰阳性菌检出率高于革兰阴性菌,金黄色葡萄球菌检出率高于其他病原菌(P<0.05);手术时长、切口长度、合并其他部位感染、合并慢性中耳炎是人工耳蜗植入术后皮瓣感染的影响因素,术后应用抗菌药物为保护因素(P<0.05);经多元Logistic回归分析得到人工耳蜗植入术患者术后出现皮瓣感染的风险预测模型,P=1/[1+e^((-1.985+0.524X手术时长+0.986X切口长度+0.801X合并其他部位感染+0.843X合并慢性中耳炎-0.764X术后应用抗菌药物))]。Hosmer-Lemeshow检验显示,其与观测值的拟合度较好(P=0.976);ROC曲线分析,预测模型预测人工耳蜗植入术患者术后出现皮瓣感染的曲线下面积(AUC)为0.880,95%CI:0.833~0.926。结论金黄色葡萄球菌是人工耳蜗植入术后皮瓣感染的主要病原菌,通过多元Logistic回归建立的风险预测模型对患者术后出现皮瓣感染具有较高的预测价值。

OBJECTIVE To explore the etiology of skin flap infection after cochlear implantation,and to construct a predictive risk model.METHODS A total of 82patients with skin flap infection after cochlear implantation admitted in Changzhou Second People′s Hospital Affiliated to Nanjing Medical University were selected as the infection group between Aug.2018and Aug.2021,and the etiological characteristics of patients with flap infection were statistically analyzed.And 207patients without infection after cochlear implantation during the same period were selected as the control group.The general data between the two groups were compared.Multivariate Logistic regression was used to analyze the factors influencing postoperative skin flap infection,and a risk prediction model was constructed.The Hosmer-Lemeshow test and receiver operating characteristic(ROC)curves were used to assess the model fit and the predictive value of postoperative skin flap infection.RESULTS A total of 85strains of pathogens were detected in 82patients with skin flap infection,among which the detection rate of Gram-positive bacteria was higher than that of Gram-negative bacteria,and the detection rate of Staphylococcus aureus was higher than that of the other pathogens(P<0.05).Length of surgery,incision length,co-infection with other sites,and co-infection with chronic otitis media were the influencing factors for flap infection after cochlear implantation,and postoperative application of antimicrobial drugs was the protective factor(P<0.05).Multivariate Logistic regression analysis showed that risk prediction model for the development of postoperative skin flap infection in patients undergoing cochlear implantation was as follow:P=1[1+e^((-1.985+0.524X operation time+0.986X incision length+0.801X infection in the other sites+0.843X chronic otitis media-0.764X postoperative prophylactic usage of antibiotics))].Hosmer-Lemeshow test showed that fit between the model and the observed value was good(P=0.976).ROC curve analysis showed that area under the curve(AUC)for the prediction model to predict postoperative flap infection in patients with cochlear implantation was 0.880,95%CI:0.833-0.926.CONCLUSION The main pathogen of skin flap infection after cochlear implantation was Staphylococcus aureus.The risk prediction model established by multivariate Logistic regression analysis had a high predictive value for patients to develop skin flap infection after surgery.