肿瘤专科医院手术患者多重耐药菌感染的危险因素分析

Analysis of Risk Factors for Multidrug-resistant Bacterial Infections in Surgical Patients in Specialized Cancer Hospital

目的:通过分析肿瘤专科医院手术患者多重耐药菌(multi-drug resistant organism,MDRO)感染的危险因素,采取针对性的预防措施,降低手术患者MDRO感染率。方法:运用回顾性调查的方法,通过医院感染数据库调取2019年1月1日—2022年12月31日于哈尔滨医科大学附属肿瘤医院117841例进行手术患者的数据,并依据《医院感染诊断标准》进行诊断。比较两组基本资料、MDRO感染患者病原体检出情况及构成比,多因素logistic回归分析MDRO感染影响因素。结果:两组年龄、手术时长、住院时长、导尿管使用时长、中心静脉管使用时长、男性、使用导尿管、使用中心静脉导管、转入ICU、进行输血、二次手术比较,差异有统计学意义(P<0.05)。MDRO感染患者共检出277株多重耐药菌,其中,G-杆菌占比为61.7%,G+球菌占比为38.3%,其中以大肠埃希菌为主,其次为鲍曼/醋酸钙不动杆菌复合体、表皮葡萄球菌,送检标本以痰标本为主(38.5%)。多因素logistic回归分析结果显示,年龄、住院时长、手术时长、使用中心静脉导管、转入过ICU是MDRO的独立危险因素(P<0.05)。结论:年龄越大、手术时长和住院时长越长、使用中心静脉导管及转入过ICU均会增加手术患者MDRO感染风险。

Objective:To analyze the risk factors of multi-drug resistant organism(MDRO)infection in surgical patients in cancer hospitals,targeted preventive measures were taken to reduce the MDRO infection rate in surgical patients.Method:Using the method of retrospective investigation,the data of 117,841 patients who underwent surgery in Harbin Medical University Cancer Hospital from January 1,2019 to December 31,2022 were collected from the hospital infection database,and the diagnosis was made according to the Hospital Infection Diagnostic Criteria.The basic information,pathogen detection and composition ratio of patients with MDRO infection were compared between two groups,and the influencing factors of MDRO infection were analyzed by multivariate logistic regression.Result:There were significant differences in age,length of operation,length of hospitalization,length of catheter use,length of central venous catheter use,male,use of catheter,use of central venous catheter,transfer to ICU,blood transfusion and secondary operation between two groups(P<0.05).A total of 277 strains of multidrug-resistant bacteria were detected in patients with MDRO infection,among them,G-bacilli accounted for 61.7%,and G+cocci accounted for 38.3%,among them,Escherichia coli was the main,followed by Baumanii/Acinetobacter calcoaceticus complex and Staphylococcus epidermidis,the submitted specimens were mainly sputum specimens(38.5%).Multivariate logistic regression analysis showed that age,length of hospital stay,length of surgery,use of central venous catheter,and transfer to ICU were independent risk factors for MDRO(P<0.05).Conclusion:The older the age,the longer the operation time and hospitalization time,the use of central venous catheter and the transfer to ICU will increase the risk of MDRO infection in surgical patients.