摘要
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人口学信息、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（26.0 d，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�
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 singlecenter and prospective observational study was performed in patients who were divided into SSI group and nonSSI group according to postoperative SSI. 〖HQK〗Demographic information, digestive tract fistula information, duration of hospital stay and SSIrelated information were collected and analyzed. Measurement data were presented as M（Qn） and analyzed by the ranksum 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 βlactamase （＋）, and 7 of them were MRSA （87.5%）. The median duration of total hospital stay and postoperative hospital stay in the nonSSI group were 33.0 days （2
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2015年第10期835-838,共4页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金面上项目（81270478）
关键词
腹部污染切口
手术部位感染
致病菌分布
Abdominal contaminated wound
Surgical site infection
Distribution of pathogens
