乳腺良性疾病日间手术后手术部位感染病原学和危险因素及与TLR4基因多态性的关联

Etiological characteristics and risk factors for postoperative surgical site infection in benign breast disease patients undergoing day surgery and association with TLR4 gene polymorphisms

目的 探究乳腺良性疾病日间手术后手术部位感染的病原学特点、危险因素及与TOLL受体4(TLR4)基因多态性的关联。方法 回顾性选取2020年5月-2023年5月西南医科大学附属医院856例行日间手术的乳腺良性疾病患者的临床资料,根据是否发生术后手术部位感染分为感染组51例和未感染组805例。统计乳腺良性疾病患者日间手术后手术部位感染病原学特点,分析其危险因素及TLR4基因多态性。结果 856例行日间手术的乳腺良性疾病患者发生术后手术部位感染51例(5.96%),共分离出52株病原菌,构成比最高的为革兰阴性菌中的铜绿假单胞菌、革兰阳性菌中的金黄色葡萄球菌。年龄大、糖尿病、术前未预防性使用抗菌药物、血清白蛋白水平高均为乳腺良性疾病患者日间手术后手术部位感染的危险因素(P<0.05)。感染组TLR4基因多态性位点rs2737190基因型GA占比高于未感染组,GG、AA占比低于未感染组(P<0.05)。结论 乳腺良性疾病患者日间手术后手术部位感染发生风险较高,以革兰阴性菌中的铜绿假单胞菌、革兰阳性菌中的金黄色葡萄球菌为主,年龄大、糖尿病、术前未预防性使用抗菌药物、血清白蛋白水平高是其危险因素,而TLR4基因多态性位点rs2737190基因型与乳腺良性疾病患者日间手术后手术部位感染的发生存在一定关系。

OBJECTIVE To explore the etiological characteristics and risk factors for postoperative surgical site in-fection in the benign breast disease patients undergoing day surgery and analyze the association with gene polymor-phisms of Toll-like receptor 4(TLR4).METHODS The clinical data were retrospectively collected from 856 pa-tients with benign breast diseases who underwent the day surgery in the Affiliated Hospital of Southwest Medical University from May 2020 to May 2023.The enrolled patients were divided into the infection group with 51 cases and the no infection group with 805 cases according to the status of postoperative surgical site infection.The etio-logical characteristics of the postoperative surgical site infection were statistically analyzed;the risk factors and TLR4 gene polymorphisms were observed.RESULTS Among the 856 patients with benign breast diseases who un-derwent the day surgery,51 had postoperative surgical site infection,accounting for 5.96%.Totally 52 strains of pathogens were isolated;Pseudomonas aeruginosa of the gram-negative bacteria and Staphylococcus aureus of the gram-positive bacteria were the predominant species of pathogens.The old age,diabetes mellitus,no preoperative prophylactic use of antibiotics and high level of serum albumin were the risk factors for the postoperative surgical site infection in the patients with benign breast diseases(P<0.05).The proportion of GA genotype at rs2737190 locus of TLR4 gene of the infection group was higher than that of the no infection group,while the proportions of GG and AA genotypes of the infection group were lower than those of the no infection group(P<0.05).CONCLUSION The patients with benign breast diseases are at high risk of surgical site infection after the day sur-gery.P.aeruginosa of the gram-negative bacteria and S.aureus of the gram-positive bacteria are the predominant species of pathogens.The old age,diabetes mellitus,no preoperative prophylactic use of antibiotics and high level of serum albumin are the risk factors.There is certain association between the genotypes at rs2737190 locus of TLR4 gene and the occurrence of postoperative surgical site infection in the benign breast disease.