腹部污染切口术后手术部位感染和致病菌分布的前瞻性研究
복부오염절구술후수술부위감염화치병균분포적전첨성연구
Surgical site infection and distribution of pathogens of abdominal contaminated wound: a prospective study
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    Chinese Journal of Digestive Surgery
    2015年 10期 835-838 ,共4页

    樊跃平%任建安%吴秀文%顾国胜%王革非%赵坤%赵允召%黎介寿

    번약평%임건안%오수문%고국성%왕혁비%조곤%조윤소%려개수

    腹部污染切口%手术部位感染%致病菌分布 腹部汙染切口%手術部位感染%緻病菌分佈
    복부오염절구%수술부위감염%치병균분포
    Abdominal contaminated wound%Surgical site infection%Distribution of pathogens
    目的 探讨腹部污染切口术后手术部位感染情况及致病菌分布的特点.方法 选取2011年11月至2013年11月于南京军区南京总医院住院并拟行确定性手术的760例消化道瘘患者进行前瞻性研究.手术部位感染的确诊依据美国疾病控制与预防中心的院内感染监测系统的标准.采用单中心、前瞻性观察性法根据术后是否出现手术部位感染将患者分为手术部位感染组和非手术部位感染组,收集并分析两组患者入口学信息、消化道瘘信息、住院时间、手术部位感染相关信息等.计量资料以M(Qn)表示,采用秩和检验.结果 筛选出符合研究条件的191例患者纳入研究,51例发生手术部位感染,总发生率为26.70％(51/191).其中浅表切口型手术部位感染36例,深层组织切口型手术部位感染8例,器官和(或)腔隙型手术部位感染7例.手术部位感染时间多为术后1周.手术部位感染组患者中,5例患者细菌培养阴性,46例患者细菌培养阳性,共分离出菌株71株,依次为大肠埃希菌22株、肠球菌14株、肺炎克雷伯菌9株、金黄色葡萄球菌8株、变形杆菌7株、铜绿假单胞菌4株、柠檬酸细菌2株、D群链球菌2株、摩根菌1株、肠杆菌1株、产气单胞菌1株.22株大肠埃希菌中,72.7％(16/22)为超广谱β-内酰胺酶阳性,8株金黄色葡萄球菌均为β-内酰胺酶阳性,其中7株为甲氧西林耐药金黄色葡萄球菌.非手术部位感染组患者中位总住院时间和中位术后住院时间分别为33.0 d(26.0d,46.0 d)和16.5 d(13.0 d,21.0 d),明显短于手术部位感染组的37.0 d(31.0 d,64.0 d)和23.0 d(17.0 d,32.0 d),两组比较,差异有统计学意义(Z=2 582.00,1 757.00,P＜0.05).结论 胃肠消化道瘘作为一种污染的腹部切口,行确定性手术治疗后手术部位感染的发生率较高;常见致病菌为大肠埃希菌、肠球菌、肺炎克雷伯菌及金黄色葡萄球菌,且部分致病菌为耐药菌株.临床试验注册 在中国临床试验注册中心注册,注册号为ChiCTR-EOC-14005670.
    목적 탐토복부오염절구술후수술부위감염정황급치병균분포적특점.방법 선취2011년11월지2013년11월우남경군구남경총의원주원병의행학정성수술적760례소화도루환자진행전첨성연구.수술부위감염적학진의거미국질병공제여예방중심적원내감염감측계통적표준.채용단중심、전첨성관찰성법근거술후시부출현수술부위감염장환자분위수술부위감염조화비수술부위감염조,수집병분석량조환자입구학신식、소화도루신식、주원시간、수술부위감염상관신식등.계량자료이M(Qn)표시,채용질화검험.결과 사선출부합연구조건적191례환자납입연구,51례발생수술부위감염,총발생솔위26.70％(51/191).기중천표절구형수술부위감염36례,심층조직절구형수술부위감염8례,기관화(혹)강극형수술부위감염7례.수술부위감염시간다위술후1주.수술부위감염조환자중,5례환자세균배양음성,46례환자세균배양양성,공분리출균주71주,의차위대장애희균22주、장구균14주、폐염극뢰백균9주、금황색포도구균8주、변형간균7주、동록가단포균4주、저몽산세균2주、D군련구균2주、마근균1주、장간균1주、산기단포균1주.22주대장애희균중,72.7％(16/22)위초엄보β-내선알매양성,8주금황색포도구균균위β-내선알매양성,기중7주위갑양서림내약금황색포도구균.비수술부위감염조환자중위총주원시간화중위술후주원시간분별위33.0 d(26.0d,46.0 d)화16.5 d(13.0 d,21.0 d),명현단우수술부위감염조적37.0 d(31.0 d,64.0 d)화23.0 d(17.0 d,32.0 d),량조비교,차이유통계학의의(Z=2 582.00,1 757.00,P＜0.05).결론 위장소화도루작위일충오염적복부절구,행학정성수술치료후수술부위감염적발생솔교고;상견치병균위대장애희균、장구균、폐염극뢰백균급금황색포도구균,차부분치병균위내약균주.림상시험주책 재중국림상시험주책중심주책,주책호위ChiCTR-EOC-14005670.
    Objective To investigate the characteristics of surgical site infection(SSI) and distribution of pathogens of abdominal contaminated wound.Methods The clinical data of 760 patients with digestive tract fistula who were prepared to undergo definitive operation at the Nanjing General Hospital of Nanjing Military Command between November 2011 and November 2013 were prospectively analyzed.Criteria for National Nosocomial Infection Surveillance (NNIS) of Centers for Disease Control and Prevention Definition (CDC) were used to determine SSI.A single-center and prospective observational study was performed in patients who were divided into SSI group and non-SSI group according to postoperative SSI.Demographic information, digestive tract fistula information, duration of hospital stay and SSI-related information were collected and analyzed.Measurement data were presented as M(Qn) and analyzed by the rank-sum test.Results Among 191 cases enrolled in the clinical trial, 51 patients developed SSI with overall incidence of 26.70％, including 36 cases of superficial incisional SSI, 8 cases of deep incisional SSI, and 7 cases of organic/lacunar SSI.SSI occured usually at postoperative week 1.Among the patients in the SSI group, bacteria culture was negative in 5 cases, and positive in 46 cases.There were 71 strains of pathogens separated from SSI group, including 22 strains of Escherichia coli, 14 strains of Enterococcus, 9 strains of Klebsiella pneumonia, 8 strains of Staphylococcus aureus, 7 strains of proteusbacillus vulgaris, 4 strains of Pseudomonas aeruginosa, 2 strains of Citrobacter, 2 strains of group D streptococcus, 1 strain of Morganella, 1 strain of Enterobacter and 1 strain of Aeromonas.A proportion of 72.7％ (16/22) of Escherichia coli were ESBL (±).All the 8 strains of Staphylococcus aureus were 3-lactamase (±), and 7 of them were MRSA (87.5％).The median duration of total hospital stay and postoperative hospital stay in the non-SSI group were 33.0 days (26.0 days, 46.0 days) and 16.5 days (13.0 days, 21.0 days), which were significantly shorter than 37.0 days (31.0 days, 64.0 days) and 23.0 days (17.0 days, 32.0 days) in the SSI group (Z =2 582.00, 1 757.00, P ＜ 0.05).Conclusions The incidence of SSI is high after definitive operation because digestive tract fistula is a kind of abdominal contaminated wound.The common pathogens are Escherichia coli,Enterococcus, Klebsiella pneumonia and Staphylococcus aureus, some of which are drug resistant.Registry This study was registered in Chinese Clinical Trial Registry with the registry number of ChiCTR-EOC-14005670.
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