摘要
目的调查神经外科手术部位感染情况并分析血清淀粉样蛋白A(SAA)、肝素结合蛋白(HBP)对感染的预测价值。方法对2019年1月-2022年12月丽水市中心医院2930例神经外科手术患者进行回顾性调查,统计手术部位感染情况,分析不同感染类型的一般临床资料以及感染患者的病原菌分布情况,采用Logistic回归分析手术部位感染的独立影响因素,通过绘制受试者工作特征(ROC)曲线分析术后血清SAA、HBP对手术部位感染的预测价值。结果2930例患者中,术后发生手术部位感染47例,发生率为1.60%,其中表浅切口感染9例,占比19.15%,器官腔隙感染38例,占比80.85%;47例切口感染患者中,33例检测到细菌,其中金黄色葡萄球菌是最常见的病原菌,占比36.54%;Logistic多因素回归分析显示,手术所在洁净手术室等级、使用植入物及血清SAA、HBP水平均为手术部位感染的相关影响因素(P<0.05);ROC曲线显示,血清SAA、HBP联合预测手术部位感染的敏感度、特异度、曲线下面积分别为83.91%、67.92%、0.860。结论神经外科手术部位感染发生率较高,金黄色葡萄球菌为主要病原菌,手术所在洁净手术室等级、使用植入物以及血清SAA、HBP水平是感染的独立相关因素,尤其是SAA和HBP,作为联合预测标志物,对手术部位感染的预测具有重要的临床价值。
OBJECTIVE To investigate the incidence of surgical site infection in neurosurgery and to analyze the di-agnostic value of serum amyloid A(SAA)and heparin-binding protein(HBP)for infections.METHODS A retro-spective survey was conducted on 2930 neurosurgical patients in Lishui Central Hospital from Jan 2019 to Dec 2022,and the surgical site infection was recorded and the general clinical data of different infection types and dis-tribution of pathogenic bacteria in patients with infection were analyzed.Multivariate logistic regression was used to analyze the independent influencing factors of surgical site infections,and the ROC curve was drawn to assess the predictive value of SAA and HBP levels on the first day after surgery for surgical site infections.RESULTS A-mong 2930 patients,there were 47 cases of postoperative surgical site infection with the incidence rate of 1.60%,including 9 cases of superficial incision infection(19.15%)and 38 cases of organ lacunar infection(80.85%).Bacteria were detected in 33 cases of 47 patients with incision infection,among which Staphylococcus aureus was the most common pathogen,accounting for 36.54%.Multivariate logistic regression analysis showed that the cleanliness level of the operating room,the use of implants,and the serum levels of SAA and HBP after surgery were independent factors related to surgical site infections(P<0.05).The ROC curve showed the combined pre-dictive value of SAA and HBP after surgery for surgical site infections,with the sensitivity of 83.91%,specificity of 67.92%,and an area under the curve of 0.860.CONCLUSION The incidence rate of surgical site infection after neurosurgical procedure is relatively high,and S.aureus is the main pathogen.The cleanliness level of the operat-ing room,the use of implants,and the serum levels of SAA and HBP are independent factors associated with in-fections.Notably,the predictive value of SAA and HBP combined detection plays a significant clinical role in pre-dicting surgical site infections.
作者
徐伟丹
潘昌玲
徐丽英
艾洁
辛百龙
杨莉
XU Wei-dan;PAN Chang-ling;XU Li-ying;AI Jie;XIN Bai-long;YANG Li(Lishui Central Hospital,Lishui,Zhejiang 323000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2024年第7期1021-1025,共5页
Chinese Journal of Nosocomiology
基金
浙江省医药卫生科技计划项目(2022ZH020)。
关键词
神经外科手术
手术部位感染
病原菌
危险因素
淀粉样蛋白A
肝素结合蛋白
Neurosurgical procedure
Surgical site infection
Pathogenic bacteria
Risk factor
Serum amyloid A
Heparin-binding protein
