三级和四级手术一类切口手术部位感染临床特点及危险因素

Clinical characteristics and risk factors for surgical site infections of type Ⅰ incision in patients undergoing grade Ⅲ and Ⅳ surgeries

    摘要
  • 摘要:
    目的 探索三级和四级手术一类切口手术部位感染(SSI)的临床特点及危险因素, 为有效防控SSI提供理论依据。
    方法 前瞻性收集2021年1月-2024年6月嘉兴大学附属第二医院重点科室收治的三级和四级手术一类切口SSI患者280例和随机抽样选取无感染患者280例的临床资料，分为感染组与无感染组，分析SSI临床特点。收集入组患者一般资料，包括性别、年龄、高血压、糖尿病、高血脂、心脏病、肝肾功能、营养情况、术前住院天数、手术时间、植入物、急诊手术、术中保暖、显微镜、出血量、输血及术后重症监护病房(ICU)、严重低蛋白血症等。采用单因素分析及logistic回归分析影响SSI的危险因素。
    结果 神经外科、骨科、心胸外科手术共16 706例，发生SSI共280例，SSI发生率1.68%，检出264株病原菌，革兰阳性菌占53.03%，革兰阴性菌占46.97%，金黄色葡萄球菌是最常见的病原菌。多因素logistic分析结果显示营养情况、手术时间、显微镜、术后ICU和严重低蛋白血症是SSI的危险因素(P < 0.05)。
    结论 三级和四级手术一类切口发生SSI并不少见，临床上可根据这些危险因素早期进行针对性干预。

     

    Abstract:
    OBJECTIVE To explore the clinical characteristics and risk factors for surgical site infections (SSI) in the patients undergoing type Ⅰ incision surgeries of grade Ⅲ and Ⅳ so as to provide theoretical bases for effective prevention and control of SSI.
    METHODS The clinical data were prospectively collected from 280 patients with SSI who received major type Ⅰ incision surgeries of grade Ⅲ and Ⅳ in the key departments of the Second Affiliated Hospital of Jiaxing University from Jan. 2021 to Jun. 2024, and randomly from another 280 patients without infections. The enrolled patients were assigned as the infection group and the no infection group, respectively. The clinical characteristics of the SSI were analyzed. The baseline data, including sex, age, hypertension, diabetes mellitus, hyperlipidemia, heart disease, hepatorenal function, nutrition status, preoperative length of hospital stay, operation duration, implantation materials, emergency surgery, intraoperative warm maintenance, microscope, blood loss volume, blood transfusion and postoperative intensive care unit (ICU) stay as well as severe hypoproteinemia, were collected from the enrolled patients. Univariate analysis and logistic regression analysis were performed for the influencing factors for the SSI.
    RESULTS A total of 16, 706 patients underwent neurosurgery, orthopedics and cardiothoracic surgery, 280 of whom had SSI, the incidence of SSI was 1.68%. Totally 264 strains of bacteria were isolated, 53.03% of which were gram-positive bacteria, 46.97% were gram-negative bacteria; Staphylococcus aureus was the most common species of pathogenic bacteria. The result of multivariate logistic analysis showed that the nutrition status, operation duration, microscope, postoperative ICU and severe hypoproteinemia were the risk factors for the SSI (P < 0.05).
    CONCLUSIONS The SSI is common among the patients undergoing typeⅠ incision surgeries of grade Ⅲ and Ⅳ. It is necessary for the hospital to take targeted intervention measures in early stage based on the risk factors.

     

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