颅脑外伤急诊手术患者切口感染的临床特点及影响因素分析
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摘要
目的详细了解颅脑外伤急诊手术患者发生切口感染病原学临床特点及导致其发生感染的相关影响因素。方法选择颅脑损伤急诊术后患者179例,采集患者术后切口分泌物标本,对患者切口感染病原菌及耐药性进行分析。记录患者相关因素,分析导致患者发生切口感染的相关影响因素。结果 179例患者,切口感染32例,感染率为17.88%。分离出病原菌49株,以革兰阳性菌为主,占63.27%,革兰阴性菌占30.61%;主要革兰阳性菌对青霉素和苯唑西林有着较高的耐药性达80.0%以上,革兰阴性菌对于卡那霉素有着较高的耐药性,达60.0%以上;结果显示,手术时间>3h、III类切口类型、合并相关基础性疾病、合并相关侵入性操作及住院时间>2周是导致感染的独立影响因素。结论颅脑损伤急诊手术患者切口感染主要以表皮葡萄球菌和凝固酶阴性葡萄球菌为主。导致切口感染的相关因素较多,针对其主要影响因素采取相关干预措施,对于提高患者预后及降低颅脑损伤急诊手术患者发生切口感染率有着重要意义。
OBJECTIVE To explore the etiological and clinical characteristics of incision infections in the craniocerebral trauma patients undergoing emergency surgery and analyze the influencing factors for the infections.METHODS A total of 179 patients with craniocerebral trauma were enrolled in the study,the incision secretions specimens were collected from the patients after the surgery,the distribution and drug resistance of pathogens causing the incision infections were observed,the related factors were recorded,and the influencing factors for the incision infections were observed.RESULTS Of the 179 patients undergoing emergency surgery,32 had incision infections,with the infection rate 17.88%.Totally 49 strains of pathogens were isolated,63.27% of which were gram-positive bacteria,and 30.61% were gram-negative bacteria.The drug resistance rates of the major species of gram-positive bacteria to penicillin and oxacillin were more than 80.0%,the drug resistance rate of the gramnegative bacteria to kalamycin was more than 60.0%.The result showed that the operation duration more than 3 hours,type III incision,complication with underlying diseases,invasive procedures and length of hospital stay more than 2 weeks were the independent influencing factors for the infections.CONCLUSION Staphylococcus epidermidis and coagulase-negative Staphylococcus are the predominant species of pathogens causing the incision infections in the craniocerebral trauma patients undergoing emergency surgery.There are a variety of factors leading to the incision infections.It is of great significance to put forward targeted interventions according to the major influencing factors so as to improve the prognosis and reduce the incidence of incision infections in the craniocerebral trauma patients undergoing emergency surgery.
OBJECTIVE To explore the etiological and clinical characteristics of incision infections in the craniocerebral trauma patients undergoing emergency surgery and analyze the influencing factors for the infections.METHODS A total of 179 patients with craniocerebral trauma were enrolled in the study,the incision secretions specimens were collected from the patients after the surgery,the distribution and drug resistance of pathogens causing the incision infections were observed,the related factors were recorded,and the influencing factors for the incision infections were observed.RESULTS Of the 179 patients undergoing emergency surgery,32 had incision infections,with the infection rate 17.88%.Totally 49 strains of pathogens were isolated,63.27% of which were gram-positive bacteria,and 30.61% were gram-negative bacteria.The drug resistance rates of the major species of gram-positive bacteria to penicillin and oxacillin were more than 80.0%,the drug resistance rate of the gramnegative bacteria to kalamycin was more than 60.0%.The result showed that the operation duration more than 3 hours,type III incision,complication with underlying diseases,invasive procedures and length of hospital stay more than 2 weeks were the independent influencing factors for the infections.CONCLUSION Staphylococcus epidermidis and coagulase-negative Staphylococcus are the predominant species of pathogens causing the incision infections in the craniocerebral trauma patients undergoing emergency surgery.There are a variety of factors leading to the incision infections.It is of great significance to put forward targeted interventions according to the major influencing factors so as to improve the prognosis and reduce the incidence of incision infections in the craniocerebral trauma patients undergoing emergency surgery.
引文
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[8]毛瑞,董乐,杨美娟,等.颅脑外伤患者术后肺部感染影响因素及病原菌药敏情况研究[J].中华医院感染学杂志,2017,27(6):1289-1292.
[9]McCabe JT,Moratz C,Liu Y,et al.Application of high-intensity focused ultrasound to the study of mild traumatic brain injury[J].Ultrasound Med Biol,2014,40(5):965-978.
[10]王伟红.手术患者发生切口感染的手术室相关因素分析及护理对策[J].护士进修杂志,2013,28(9):786-789.
[11]Radcliff KE,Rasouli MR,Neusner A,et al.Preoperative delay of more than 1hour increases the risk of surgical site infection[J].Spine(Phila Pa 1976),2013,38(15):1318-1323.
[12]Rahmati H,Sharif F,Davarpanah MA.Needle magnet for prevention of sharps injury to operating room personnel[J].JHosp Infect,2010,75(3):237-238.
[13]孙建兰,周洪兰.循证护理干预对ICU重症颅脑外伤患者院内感染的预防效果研究[J].实用临床医药杂志,2017,21(10):10-13.
[14]庄小琴,张小如,陈玉红,等.手术室腹部手术患者切口感染的相关因素分析与预防对策[J].中华医院感染学杂志,2017,27(14):3346-3349.
[15]Zhang B,Liu Z,Lin Z,et al.Microbiologic characteristics of pathogenic bacteria from hospitalized trauma patients who survived Wenchuan earthquake[J].Eur J Clin Microbiol Infect Dis,2012,31(10):2529-2535.
[2]陈旭华.急诊处置132例严重颅脑外伤临床体会[J].实用临床医药杂志,2011,15(21):154-156.
[3]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[4]许根友.学习《全国临床检验操作规程》(第3版)第一篇对检验工作的实际意义[J].临床血液学杂志(输血与检验版),2010,23(6):759-760.
[5]张雅薇,王辉.2016年CLSIM100S(第26版)主要更新内容解读[J].中华检验医学杂志,2016,39(3):165-169.
[6]Munoz-Price LS,Birnbach DJ,Lubarsky DA,et al.Decreasing operating room environmental pathogen contamination through improved cleaning practice[J].Infect Control Hosp Epidemiol,2012,33(9):897-904.
[7]危晴天,孙道法,许刚,等.小儿颅脑外伤术后院内感染的病原菌分布及耐药性监测[J].中国实用神经疾病杂志,2016,19(7):53-55.
[8]毛瑞,董乐,杨美娟,等.颅脑外伤患者术后肺部感染影响因素及病原菌药敏情况研究[J].中华医院感染学杂志,2017,27(6):1289-1292.
[9]McCabe JT,Moratz C,Liu Y,et al.Application of high-intensity focused ultrasound to the study of mild traumatic brain injury[J].Ultrasound Med Biol,2014,40(5):965-978.
[10]王伟红.手术患者发生切口感染的手术室相关因素分析及护理对策[J].护士进修杂志,2013,28(9):786-789.
[11]Radcliff KE,Rasouli MR,Neusner A,et al.Preoperative delay of more than 1hour increases the risk of surgical site infection[J].Spine(Phila Pa 1976),2013,38(15):1318-1323.
[12]Rahmati H,Sharif F,Davarpanah MA.Needle magnet for prevention of sharps injury to operating room personnel[J].JHosp Infect,2010,75(3):237-238.
[13]孙建兰,周洪兰.循证护理干预对ICU重症颅脑外伤患者院内感染的预防效果研究[J].实用临床医药杂志,2017,21(10):10-13.
[14]庄小琴,张小如,陈玉红,等.手术室腹部手术患者切口感染的相关因素分析与预防对策[J].中华医院感染学杂志,2017,27(14):3346-3349.
[15]Zhang B,Liu Z,Lin Z,et al.Microbiologic characteristics of pathogenic bacteria from hospitalized trauma patients who survived Wenchuan earthquake[J].Eur J Clin Microbiol Infect Dis,2012,31(10):2529-2535.