胰腺癌术后医院感染病原学特点及影响因素探究
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摘要
目的探究胰腺癌术后医院感染的影响因素及感染病原学特点。方法回顾性分析2011年6月-2017年6月医院收治的289例胰腺癌手术治疗患者临床资料,根据术后是否感染分为感染组和非感染组,对比两组患者一般临床资料,治疗、手术及术后并发症等情况。观察术后感染患者病原学特点,采用单因素及多因素Logistic分析探究胰腺癌术后发生感染的影响因素。结果胰腺癌患者术后发生医院感染27例,感染率为9.34%,术后感染患者临床送检标本共培养病原菌40株,革兰阴性菌24株占60.0%,其中以大肠埃希菌为主,革兰阳性菌10株占25.0%,其中以屎肠球菌为主,真菌6株占15.0%;合并糖尿病、术前血清白蛋白水平低、术中出血量大、术中输血、围手术期抗菌药物使用、中心静脉置管、留置导尿时间长,术后胰瘘、胆瘘、住ICU时间和总住院时间为胰腺癌患者术后发生医院感染的影响因素,多因素logistic回归分析显示:并发胰瘘、胆瘘及术中输血是术后感染的独立性影响因素。结论胰腺癌术后并发胰瘘、胆瘘及术中输血是术后感染的影响因素,术中规范操作尽量降低胰瘘、胆瘘发生率,尽量避免术中输血可降低术后感染率。
OBJECTIVE To explore the influencing factors and etiological characteristics of postoperative nosocomial infection in the patients with pancreatic cancer.METHODS The clinical data of 289 pancreatic cancer patients who received surgical procedures in the hospital from Jun 2011 to Jun 2017 were retrospectively analyzed,the patients were divided into the infection group and the non-infection group according to the status of infection.The baseline clinical data,treatment,surgery and incidence of postoperative complications were compared between the two groups of patients.The etiological characteristics of the postoperative infection were observed,and the univariate analysis and multivariate logistic analysis were performed for the influencing factors for the postoperative infection.RESULTS Totally 27 patients had postoperative nosocomial infection,with the infection rate 9.34%.A total of 40 strains of pathogens were isolated from the clinical submitted specimens that were obtained from the patients with postoperative infection,24(60.0%)of which were gram-negative bacteria,10(25.0%)were gram-positive bacteria,and 6(15.0%)were fungi;Escherichia coli was the predominant species of the gram-negative bacteria;Enterococcus faecium was dominant among the gram-positive bacteria.The influencing factors for the postoperative nosocomial infection in the patients with pancreatic cancer included complication with diabetes mellitus,low level of preoperative serum albumin,large volume of intraoperative bleeding,intraoperative blood transfusion,perioperative use of antibiotics,central venous catheterization,long time of urinary catheter indwelling,postoperative pancreatic fistula,biliary fistula,length of ICU stay and total length of hospital stay.The multivariate logistic regression analysis showed that complication with pancreatic fistula,biliary fistula and intraoperative blood transfusion were the independent influencing factors for the postoperative infection.CONCLUSIONThe complication with pancreatic fistula,biliary fistula and intraoperative blood transfusion are the influencing factors for the postoperative infection.It is necessary to conform to the standard operation procedures during the surgery,reduce the incidence of pancreatic fistula and biliary fistula and try to avoid the intraoperative blood transfusion so as to reduce the incidence of postoperative infection.
OBJECTIVE To explore the influencing factors and etiological characteristics of postoperative nosocomial infection in the patients with pancreatic cancer.METHODS The clinical data of 289 pancreatic cancer patients who received surgical procedures in the hospital from Jun 2011 to Jun 2017 were retrospectively analyzed,the patients were divided into the infection group and the non-infection group according to the status of infection.The baseline clinical data,treatment,surgery and incidence of postoperative complications were compared between the two groups of patients.The etiological characteristics of the postoperative infection were observed,and the univariate analysis and multivariate logistic analysis were performed for the influencing factors for the postoperative infection.RESULTS Totally 27 patients had postoperative nosocomial infection,with the infection rate 9.34%.A total of 40 strains of pathogens were isolated from the clinical submitted specimens that were obtained from the patients with postoperative infection,24(60.0%)of which were gram-negative bacteria,10(25.0%)were gram-positive bacteria,and 6(15.0%)were fungi;Escherichia coli was the predominant species of the gram-negative bacteria;Enterococcus faecium was dominant among the gram-positive bacteria.The influencing factors for the postoperative nosocomial infection in the patients with pancreatic cancer included complication with diabetes mellitus,low level of preoperative serum albumin,large volume of intraoperative bleeding,intraoperative blood transfusion,perioperative use of antibiotics,central venous catheterization,long time of urinary catheter indwelling,postoperative pancreatic fistula,biliary fistula,length of ICU stay and total length of hospital stay.The multivariate logistic regression analysis showed that complication with pancreatic fistula,biliary fistula and intraoperative blood transfusion were the independent influencing factors for the postoperative infection.CONCLUSIONThe complication with pancreatic fistula,biliary fistula and intraoperative blood transfusion are the influencing factors for the postoperative infection.It is necessary to conform to the standard operation procedures during the surgery,reduce the incidence of pancreatic fistula and biliary fistula and try to avoid the intraoperative blood transfusion so as to reduce the incidence of postoperative infection.
引文
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[16]雷雨颖,李斐,陈广军,等.老年胰腺癌患者术后肠道真菌感染的危险因素分析[J].中华医院感染学杂志,2014,29(18):4563-4565.
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[18]张军峰,孙勇伟,花荣,等.胰腺术后腹腔感染的分析及治疗[J].中华肝胆外科杂志,2014,20(7):519-523.
[2]梁辉.胆系疾病开腹手术术后感染危险因素分析及防治[D].浙江大学,2015:158-161.
[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]刘其雨,李立,夏红天,等.胰十二指肠切除术后胰瘘发生的相关因素[J].解放军医学院学报,2014,35(11):1109-1111.
[5]孙建华,胡曼.糖尿病及术后血糖对胰腺癌预后的影响[J].世界最新医学信息文摘,2017(10):224-227.
[6]雷雨颖,李斐,陈广军.老年胰腺癌患者术后肠道真菌感染的危险因素分析[J].中华医院感染学杂志,2014,24(18):4563-4565.
[7] Saxena P,Kumbhari V,Zein ME.Preoperative biliary drainage[J].Digest Scopy,2015(27):265-277.
[8]李丽芳,王娟,元燕.胰腺癌伴梗阻性黄疸患者胆道感染的病原菌分析[J].中华医院感染学杂志,2013,23(18):4399-4403.
[9] Li L,Zhang LH,Xu WP,et al.Risk assessment of ischemic stroke associated pneumonia[J].World J Emerg Med,2014,5(3):209-213.
[10]王宏伟,王崑,包全,等.胰十二指肠切除胰胃吻合术后胰瘘术前风险因素分析[J].中华普通外科杂志,2015,30(2):111-114.
[11]杨峰,傅德良,金忱,等.胰十二指肠切除术后腹腔感染细菌学和耐药性及其危险因素分析[J].中华普通外科杂志,2007,22(2):99-103.
[12]赵霞,王力红,张京利,等.外科患者术后医院感染的调查及危险因素分析[J].中华医院感染学杂志,2014,24(21):5352-5354.
[13]俞宏斌,朱炜.胰腺癌患者术后真菌感染的危险因素[J].中国消毒学杂志,2017,34(6):590-591.
[14] Delpero JR,Turrini O,Raoul JL.Management of localized,locally advanced and metastatic pancreatic adenocarcinoma[J].Rev Prat,2015,65(3):382-389.
[15]王刚,祝晓涛.胰十二指肠切除术后合并深部真菌感染8例临床分析[J].中国实用医药,2012,7(4):37-38.
[16]雷雨颖,李斐,陈广军,等.老年胰腺癌患者术后肠道真菌感染的危险因素分析[J].中华医院感染学杂志,2014,29(18):4563-4565.
[17]曾化峰.胰十二指肠切除术围术期输血对患者术后感染的影响[J].现代诊断与治疗,2014,25(1):148-149.
[18]张军峰,孙勇伟,花荣,等.胰腺术后腹腔感染的分析及治疗[J].中华肝胆外科杂志,2014,20(7):519-523.