外科手术患者术后感染病原学特点及危险因素分析.

Analysis of pathogenic characteristics and risk factors of postoperative infections in surgical patients

目的探讨外科手术患者术后感染的病原学特点,并对危险因素进行分析。方法选取2021年4月~2024年2月期间于宜春市人民医院行外科手术的286例患者为研究对象。收集患者临床资料并采用多因素logistic回归分析术后感染的影响因素。结果286例患者中32例患者发生切口感染,总感染率为11.19%。32例术后感染患者共检测出病原菌37株,其中革兰阴性菌(G^(-))占比(54.05%)最多,其次为革兰阳性菌(G^(+))(37.84%),真菌占比仅8.11%。G中以大肠埃希菌居多(35.00%),其次为铜绿假单胞菌(25.00%);G^(+)中以金黄色葡萄球菌居多(42.86%)。与未感染组相比,感染组糖尿病(χ^(2)=8.515)、急诊手术(χ^(2)=9.007)、手术时间≥2h(χ^(2)=6.948)、Ⅱ/Ⅲ类切口(χ^(2)=6.609)、侵入性操作(χ^(2)=6.128)占比显著较高(P<0.05)。多因素logistic回归结果显示,糖尿病(OR=2.107,95%CI:1.353~3.281)、急诊手术(OR=2.430,95%CI:1.515~3.897)、手术时间≥2h(OR=1.658,95%CI:1.177~2.336)、Ⅱ/Ⅲ类切口(OR=1.429,95%CI:1.114~1.833)以及侵入性操作(OR=1.385,95%CI:1.061~1.808)为术后感染的危险因素(P<0.05)。结论外科手术后感染病原菌以大肠埃希菌、金黄色葡萄球菌为主,糖尿病、急诊手术、手术时间≥2h、Ⅱ/Ⅲ类切口及侵入性操作为术后感染的危险因素。医护人员可根据危险因素进行风险评估,预防术后感染。

Objective To explore the pathogenic characteristics of postoperative infections in surgical patients and analyze the risk factors.Methods A total of 286 patients who underwent surgical procedures in Yichun People's Hospital from April 2021 to February 2024 were selected as the study subjects.Clinical data of patients were collected,and multivariate logistic regression was applied to analyze the influencing factors of postoperative infection.Results Out of 286 patients,32 patients experienced incision infections,with a total infection rate of 11.19%.A total of 37 strains of pathogenic bacteria were detected in 32 patients with postoperative infections,with Gram negative bacteria(G^(-))accounting for the most(54.05%),followed by Gram positive bacteria(G^(+))(37.84%),and fungi accounting for only 8.11%.Among G^(-),Escherichia coli was the most common(35.00%),followed by Pseudomonas aeruginosa(25.00%);among G^(+),Staphylococcus aureus was the most common(42.86%).Compared with the uninfected group,the proportions of diabetes(x²=8.515),emergency operation(χ^(2)=9.007),operation time≥2 hours(χ^(2)=6.948),class II/II incisions(x²=6.609),and invasive operation(x^(2)=6.128)were greatly higher in the infected group(P<0.05).Multivariate logistic regression results showed that diabetes(OR=2.107,95%CI:1.353-3.281),emergency surgery(OR=2.430,95%CI:1.515-3.897),operation time≥2 hours(OR=1.658,95%CI:1.177-2.336),class II/II incisions(OR=1.429,95%CI:1.114-1.833)and invasive procedures(OR=1.385,95%CI:1.061-1.808)were risk factors forpostoperative infection(P<0.05).ConclusionThe main pathogens of postoperative infections are Escherichia coli and Staphylococcus aureus.Diabetes,emergency operation,operation time≥2 hours,class II/Il incisions and invasive procedures are risk factors for postoperative infection.Medical staff can conduct risk assessments based on risk factors to prevent postoperative infections.