消化内镜术后感染患者的临床特征及影响因素分析

Analysis of the clinical characteristics and influencing factors of patients with infection after digestive endoscopy

目的探析消化内镜术后并发感染患者的临床特征、病原菌分布情况及相关影响因素,为制定预防措施提供参考依据。方法选取于本院接受治疗的85例消化内镜术后感染患者及同期90例未并发感染患者为研究对象。通过本院电子病例信息登记系统,自行设计问卷调查表,收集两组患者临床资料,对比分析消化内镜术后感染相关影响因素。结果85例术后感染患者中,胃镜治疗后感染58例,结肠镜治疗后感染27例;呼吸道感染33例,消化道感染21例,泌尿系统感染13例,皮肤黏膜感染10例,其他部位感染8例。胃镜治疗感染者中,呼吸道感染28例,消化道感染15例,泌尿系统感染5例,皮肤黏膜感染8例,其他部位感染2例。结肠镜治疗后感染者中,呼吸道感染5例,消化道感染6例,泌尿系统感染8例,皮肤黏膜感染2例,其他部位感染6例。胃镜治疗后发生感染与结肠镜治疗后发生感染患者,呼吸道、泌尿系统、其他部位占比对比差异有统计学意义(P<0.05)。共检出病原菌85株,其中革兰阴性菌共53株,革兰阳性菌共31株,真菌1株。革兰阴性菌主要为幽门螺杆菌(24.71%,21/85)和肺炎克雷伯菌(11.76%,10/85),大肠埃希菌、铜绿假单胞菌、沙门氏菌、鲍曼不动杆菌、产气肠杆菌分别占8.24%、5.88%、5.88%、3.53%、2.35%。革兰阳性菌主要为金黄色葡萄球菌(14.12%,12/85)和表皮葡萄球菌(8.24%,7/85),肺炎链球菌、粪肠球菌、放线菌分别占5.88%、4.71%、3.53%。真菌为白色假丝酵母菌。单因素分析显示:两组患者年龄、合并糖尿病、术前使用免疫抑制剂、放置引流管时间、住院时间对比差异具有统计学意义(P<0.05),性别、合并高血压、疾病类型、内镜类型对比差异不具有统计学意义(P>0.05)。进一步进行二元logistic回归分析显示:年龄≥60岁、合并糖尿病、术前使用免疫抑制剂、放置引流管时间≥7 d、住院时间≥14 d的患者进行消化内镜治疗后更容易合并术后感染(P<0.05)。结论消化内镜术后感染患者,感染部位主要以呼吸道和消化道为主,胃镜治疗后发生感染与结肠镜治疗后发生感染部位分布具有一定差异性。病原菌主要为革兰阴性菌,以幽门螺杆菌为主。老年患者、合并糖尿病、术前使用免疫抑制剂、放置引流管时间长、住院时间长患者进行消化内镜治疗后更容易发生术后感染。

Objective The clinical characteristics,distribution of pathogenic bacteria and related influencing factors of patients with concurrent infection after digestive endoscopy were explored,to provide a reference basis for formulating preventivemeasures.Methods A total of 85 patients with infection after digestive endoscopy and 90 patients without concurrent infection after digestive endoscopy who were treated in our hospital were selected as the research subjects of this study.Through the electronic case information registration system of our hospital and the self-designed questionnaire,the clinical data of the two groups of patients were collected,and the related influencing factors of infection after digestive endoscopy were compared and analyzed..ResultsAmong the 85 patients with infection after digestive endoscopy,58 cases had infection after gastroscopy treatment and 27 cases had infection after colonoscopy treatment;33 cases had respiratory tract infection,21 cases had digestive tract infection,13 cases had urinary system infection,10 cases had skin and mucous membrane infection,and 8 cases had infection in other parts.Among the patients with infection after gastroscopy treatment,28 cases had respiratory tract infection,15 cases had digestive tract infection,5 cases had urinary system infection,8 cases had skin and mucous membrane infection,and 2 cases had infection in other parts.Among the patients with infection after colonoscopy treatment,5 cases had respiratory tract infection,6 cases had digestive tract infection,8 cases had urinary system infection,2 cases had skin and mucous membrane infection,and 6 cases had infection in other parts.The proportion differences of respiratory tract,urinary system and other parts between patients with infection after gastroscopy treatment and those after colonoscopy treatment were statistically significant(P<0.05).A total of 85 pathogenic bacteria were detected,among which 53 were Gram-negative bacteria,31 were Gram-positive bacteria,and 1 was fungus.The main Gram-negative bacteria were Helicobacter pylori(24.71%,21/85)and Klebsiella pneumoniae(11.76%,10/85),and the proportions of Escherichia coli,Pseudomonas aeruginosa,Salmonella,Acinetobacter baumanni and Enterobacter aerogenes were 8.24%,5.88%,5.88%,3.53%and 2.35%respectively.The main Gram-positive bacteria were Staphylococcus aureus(14.12%,12/85)and Staphylococcus epidermidis(8.24%,7/85),and the proportions of Streptococcus pneumoniae,Enterococcus faecalis and Actinomyces were 5.88%,4.71%and 3.53%respectively.The fungus was Candida albicans.Univariate analysis showed that there were statistically significant differences in age,combined diabetes,preoperative use of immunosuppressants,drainage tube placement time,and hospital stay between the two groups(P<0.05),while there were no statistically significant differences in gender,combined hypertension,disease type,and endoscopy type between the two groups(P>0.05).Further binary Logistic regression analysis showed that patients aged≥60 years old,with diabetes,preoperative use of immunosuppressants,drainage tube placement time≥7 days,and hospital stay≥14 days were more likely to have postoperative infections after digestive endoscopy treatment(P<o.05).Conclusion For patients with infection after digestive endoscopy,the infection sites were mainly the respiratory tract and digestive tract.There were certain differences in the distribution of infection sites between patients with infection after gastroscopy treatment and those after colonoscopy treatment.The main pathogenic bacteria were Gram-negative bacteria,mainly H.pylori.Elderly patients,those with diabetes,those using immunosuppressants before surgery,those with a long duration of drainage tube placement,and those with a long hospital stay were more prone to postoperative infections after digestive endoscopy treatment.