摘要
目的分析全身麻醉患者术后医院感染的病原学特点,并构建风险预测模型.方法回顾性收集2021年9月-2022年11月义乌市中心医院收治的798例全身麻醉患者临床资料,根据患者术后是否发生医院感染分为感染组65例和未感染组733例,统计全身麻醉患者术后医院感染部位分布、感染病原学特点,单因素及多因素Logistic回归分析术后医院感染的危险因素,并构建风险预测模型,受试者工作特征(ROC)曲线分析模型的预测价值.结果65例全身麻醉患者术后医院感染主要类型为呼吸道和手术部位感染,占比分别为58.46%和26.15%;共分离出79株病原菌,主要感染病原菌种类为鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、表皮葡萄球菌;合并糖尿病、合并低蛋白血症、美国麻醉医师协会(ASA)分级Ⅲ级、麻醉通气时间≥2 h、麻醉机过滤器重复性使用、住院时间≥14 d均为全身麻醉患者术后医院感染的独立危险因素(P<0.05);根据上述因素构建的模型具有较好的预测价值,曲线下面积(AUC)为0.831,敏感度为78.46%,特异度为72.71%.结论全身麻醉患者术后医院感染主要病原菌种类为鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、表皮葡萄球菌,危险因素包括合并糖尿病、合并低蛋白血症、ASA分级Ⅲ级、麻醉通气时间≥2 h、麻醉机过滤器重复性使用、住院时间≥14 d,据此构建的预测模型具有较好的预测价值.
OBJECTIVE To observe the etiological characteristics of postoperative nosocomial infection in the general anesthesia patients and establish the risk prediction model.METHODS A total of 798 patients who received general anesthesia in Yiwu Central Hospital from Sep 2021 to Nov 2022 were enrolled in the study and were divided into the infection group with 65 cases and the no infection group with 733 cases according to the status of postoperative nosocomial infection.The postoperative infection sites and etiological characteristics of the infection were statistically analyzed.Univariate analysis and multivariate logistic regression analysis were performed for risk factors for the postoperative nosocomial infection,the risk prediction model was established,and the predictive value of the model was analyzed by means of receiver operating characteristic(ROC)curves.RESULTS Among the 65 general anesthesia patients with postoperative nosocomial infection,the patients with respiratory tract infection accounted for 58.46%,and the patients with surgical site infection accounted for 26.15%.Totally 79 strains of pathogens were isolated;the major species of the pathogens were as follows:Acinetobacter baumanni,Pseudomonas aeruginosa,Staphylococcus aureus,Staphylococcus epidermidis.Complication with diabetes mellitus,complication with hypoproteinemia,gradeⅢof American Society of Anesthesiolo gists(ASA),anesthetic ventilation duration no less than 2 hours,repeated use of anesthesia machine filter and length of hospital stay no less than 14 days were the independent risk factors for the postoperative nosocomial infection in the general anesthesia patients(P<0.05).The model that was established based on the above factors had high predictive value,the area under curve(AUC)was 0.831,with the sensitivity 78.46%,the specificity 72.71%.CONCLUSION A.baumanni,P.aeruginosa,S.aureus and S.epidermidis are the predominant species of pathogens isolated from the general anesthesia patients with postoperative nosocomial infection.The risk factor
作者
陈晓军
孙爱华
吴颜丹
吕雯琴
贾义安
CHEN Xiao-jun;SUN Ai-hua;WU Yan-dan;LYU Wen-qin;JIA Yi-an(Yiwu Central Hospital,Yiwu,Zhejiang 322000,China;不详)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2023年第18期2785-2789,共5页
Chinese Journal of Nosocomiology
基金
第二批浙江省医学支撑学科建设计划(序号11)。
关键词
全身麻醉
医院感染
病原学
危险因素
预测模型
General anesthesia
Nosocomial infection
Etiology
Risk factor
Prediction model
