肛周脓肿切口感染的病原学及影响因素分析
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摘要
目的分析肛周脓肿术后引起切口感染的影响因素,为控制切口感染及治疗提供临床参考意见。方法选取2014年1月-2016年12月医院收治的107例肛周脓肿切排术患者作为研究对象,回顾性分析患者的临床病例资料。对感染部位标本的培养和鉴定,研究切口感染的病原学特点,运用单因素以及多因素Logistics回归分析探讨其感染的影响因素。结果病原学培养结果显示革兰阴性菌30株,占76.92%,革兰阳性菌9株,占23.07%;单因素分析结果表明,深部脓肿、有肛周皮肤感染灶、住院时间长的患者更易发生切口感染,差异具有统计学意义(P<0.05)。结论导致患者切口感染的主要病原菌为革兰阴性菌。感染与深部脓肿、有肛周皮肤感染灶以及住院时间长相关,临床上应针对上述因素采取相应预防措施。
OBJECTIVE To investigate the influencing factors for postoperative incision infection in the patients with perianal abscess so as to provide guidance for control of the incision infection. METHODS A total of 107 patients who received perianal abscess resection in the hospital from Jan 2014 to Dec 2016 were enrolled in the study, the clinical data of the patients were retrospectively analyzed, the specimens were collected from the infection sites and cultured, the isolated pathogens were identified, the etiological characteristics of the incision infection were observed, and univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the infection. RESULTS The result of etiological analysis showed that there were 30(76.92%) strains of gram-negative bacteria and 9(23.07%) strains of gram-positive bacteria. The univariate analysis indicated that the patients who had deep abscess, perianal skin infection and long length of hospital stay were more likely to have the incision infection, and there were significant differences(P<0.05). CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the incision infection. The infection is associated with the deep abscess, perianal skin infection and long length of hospital stay. It is necessary for the hospital to take targeted prevention measures according to the above factors.
OBJECTIVE To investigate the influencing factors for postoperative incision infection in the patients with perianal abscess so as to provide guidance for control of the incision infection. METHODS A total of 107 patients who received perianal abscess resection in the hospital from Jan 2014 to Dec 2016 were enrolled in the study, the clinical data of the patients were retrospectively analyzed, the specimens were collected from the infection sites and cultured, the isolated pathogens were identified, the etiological characteristics of the incision infection were observed, and univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the infection. RESULTS The result of etiological analysis showed that there were 30(76.92%) strains of gram-negative bacteria and 9(23.07%) strains of gram-positive bacteria. The univariate analysis indicated that the patients who had deep abscess, perianal skin infection and long length of hospital stay were more likely to have the incision infection, and there were significant differences(P<0.05). CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the incision infection. The infection is associated with the deep abscess, perianal skin infection and long length of hospital stay. It is necessary for the hospital to take targeted prevention measures according to the above factors.
引文
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[21] 林晖,何春梅,应光耀,等.隧道式拖线术治疗高位后马蹄型肛周脓肿60例[J].中国中西医结合外科杂志,2015,21(1):51-54.
[2] 蔡尚党,徐辉,程传耀,等.肛周脓肿应用超声诊断分析[J].中华医院感染学杂志,2016,26(8):1813-1815.
[3] 程化,薛超群,邓世山.分时挂线在肛周脓肿手术中的应用[J].西部医学,2015,27(10):1542-1544.
[4] 裴景慧,王琛.负压创面治疗技术在肛周脓肿中的应用研究进展[J].中国中医急症,2016,25(1):106-109.
[5] 林丽晴,杨好意.浅表及经直肠腔内超声在肛周脓肿诊断中的应用价值[J].华中科技大学学报(医学版),2014,43(5):612-614.
[6] Xu R,Tan KK,Chong CS.Response to re:bacteriological study in perianal abscess is not useful and not cost-effective[J].ANZ J Surg,2017,87(5):421.
[7] Amaranathan A,Sahoo AK,Barathi D,et al.Retroperitoneal necrotizing fasciitis masquerading as perianal abscess - rare and perilous[J].Cureus,2017,9(1):e982.
[8] Sahnan K,Adegbola SO,Tozer PJ,et al.Perianal abscess[J].BMJ,2017,356:j475.
[9] 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.
[10] 尚红,王毓三,申子瑜.全国临床检验操作规程[M].人民卫生出版社,2015:37-39.
[11] 王崇树.肛周脓肿的诊断治疗及注意事项[J].结直肠肛门外科,2005,11(3):178-178.
[12] 王建平,杜金林,蔡成,等.肛周脓肿局部组织及外周血中IL-22的表达及临床意义[J].浙江医学,2015,37(11):958-960.
[13] Goligher JC,Ellis M,Pissidis AG.A critique of anal glandular infection in the aetiology and treatment of idiopathic anorectalabscesses and fistulas[J].Br J Surg,1967,54(12):977-983.
[14] Mukai S,Itoi T,Tsuchiya T,et al.EUS-guided pelvic abscess drainage with use of a biflanged metal stent through the perianal transgluteal route[J].Gastrointest Endosc,2016,84(6):1069-1070.
[15] McArdle DJT,McArdle JP,Jessup P,et al.Necrotizing sarcoid granulomatosis:clinico-radio-pathologic diagnosis[J].Am J Med,2017,130(7):e283-e286.
[16] Seemann NM,King SK,Elkadri A,et al.The operative management of children with complex perianal Crohn's disease[J].J Pediatr Surg,2016,51(12):1993-1997.
[17] 董青军,易进,王琛,等.拖线联合置管术治疗马蹄形伴直肠周围深部间隙肛周脓肿34例临床研究[J].江苏中医药,2015,47(7):46-47.
[18] Maconi G,Greco MT,Asthana AK.Transperineal ultrasound for perianal fistulas and abscesses - a systematic review and meta-analysis[J].Ultraschall Med,2017,38(3):265-272.
[19] Singer AA,Gadepalli SK,Eder SJ,et al.Fistulizing Crohn's disease presenting after surgery on a perianal lesion[J].Pediatrics,2016,137(3):e20152878.
[20] Ho YH,Tan M,Chui CH,et al.Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses[J].Dis Colon Rectum,1997,40(12):1435-1438.
[21] 林晖,何春梅,应光耀,等.隧道式拖线术治疗高位后马蹄型肛周脓肿60例[J].中国中西医结合外科杂志,2015,21(1):51-54.