结直肠癌术后切口医院感染病原学特点及相关因素分析
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摘要
目的了解结直肠癌术后切口医院感染的病原学特点并分析相关因素。方法选择医院2015年5月-2017年5月收治的行结直肠癌根治手术患者200例,汇总术后发生切口医院感染的患者资料,包括感染患者的病原学资料,患者自身因素、手术相关因素,分析与医院感染发生的相关性。结果 200例患者中,42例患者发生切口感染,感染率为21.00%,共检出病原菌54株,其中革兰阳性菌20株(37.04%),革兰阴性菌29株(53.70%),真菌5株(9.26%);经多因素分析,慢性阻塞性肺疾病、术前使用激素、手术切口类型、美国麻醉医师协会(ASA)分级、手术时机、脂肪液化、切口裂开、吻合口瘘是结直肠癌手术部位感染(SSI)的独立危险因素。结论结直肠癌术后切口感染的影响因素较多,准确识别感染的相关因素,对可控制的危险因素及时地纠正,加强术前、术中以及术后医院感染的防控力度,可显著降低感染率。
OBJECTIVE To investigate the etiological characteristics and related factors for postoperative incision infection in the patients with colorectal cancer. METHODS A total of 200 patients with colorectal cancer who underwent radical surgery for colorectal cancer were treated in the hospital from May 2015 to May 2017 were enrolled in the study, the data of the patients who had postoperative incision infection were collected, including the etiological data, factors of patients' own and surgery-related factors, and their association with the infection was observed. RESULTS Of the 200 patients, 42 had incision infection, with the infection rate 21.00%. Totally 54 strains of pathogens were isolated, 20(37.04%) of which were gram-positive bacteria, 29(53.70%) were gram-negative bacteria, and 5(9.26%) were fungi. Multivariate analysis showed that the independent risk factors for the surgical site infection(SSI) in the patients with colorectal cancer included chronic obstructive pulmonary disease, preoperative use of hormones, types of surgical incision, American Society of Anesthesiologists(ASA) classification, timing of surgery, fat liquefaction, rupture of incision and anastomotic fistula. CONCLUSION There are a variety of influencing factors for the postoperative incision infection in the patients with colorectal cancer. It is necessary to accurately identify the related factors for the infection, retrograde and correct the controllable risk factors in a timely manner and enhance the control of preoperative, intraoperative and postoperative nosocomial infection so as to reduce the infection rate.
OBJECTIVE To investigate the etiological characteristics and related factors for postoperative incision infection in the patients with colorectal cancer. METHODS A total of 200 patients with colorectal cancer who underwent radical surgery for colorectal cancer were treated in the hospital from May 2015 to May 2017 were enrolled in the study, the data of the patients who had postoperative incision infection were collected, including the etiological data, factors of patients' own and surgery-related factors, and their association with the infection was observed. RESULTS Of the 200 patients, 42 had incision infection, with the infection rate 21.00%. Totally 54 strains of pathogens were isolated, 20(37.04%) of which were gram-positive bacteria, 29(53.70%) were gram-negative bacteria, and 5(9.26%) were fungi. Multivariate analysis showed that the independent risk factors for the surgical site infection(SSI) in the patients with colorectal cancer included chronic obstructive pulmonary disease, preoperative use of hormones, types of surgical incision, American Society of Anesthesiologists(ASA) classification, timing of surgery, fat liquefaction, rupture of incision and anastomotic fistula. CONCLUSION There are a variety of influencing factors for the postoperative incision infection in the patients with colorectal cancer. It is necessary to accurately identify the related factors for the infection, retrograde and correct the controllable risk factors in a timely manner and enhance the control of preoperative, intraoperative and postoperative nosocomial infection so as to reduce the infection rate.
引文
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[20] Valizadeh N,Murray ACA,Suradkar K,et al.Impact of preoperative steroid or immunosuppressant use on short - term outcomes following colectomy in Crohn's disease patients[J].Tech Coloproctol,2017,21(3):217-223.
[21] 李黎,周安朋.医院不同病区细菌感染的分布及药敏分析[J].转化医学电子杂志,2016,3(2):82-83.
[22] Prin M,Guglielminotti J,Mtalimanja O,et al.Emergency-to-elective surgery ratio:a global indicator of access to surgical care[J].World J Surg,2017,42(7):1971-1980.
[23] Costa G,Lorenzon L,Massa G,et al.Emergency surgery for colorectal cancer does not affect nodal harvest comparing elective procedures:a propensity score-matched analysis[J].Int J Colorectal Dis,2017,32(10):1453-1461.
[2] Arling JD,Mccallum JC,Soden PA,et al.Predictive ability of the Society for Vascular Surgery Wound,Ischemia,and foot Infection (WIfI) classification system after first-time lower extremity revascularizations[J].J Vasc Surg,2017,65(3):695-704.
[3] 周晓华,崔海宁.择期开腹结直肠癌术后切口感染因素分析[J].中国感染与化疗杂志,2016,16(2):205-207.
[4] 彭联明,蔡晶晶,何亚光,等.术中冲洗液在结直肠癌术后切口感染预防中的应用[J].中国内镜杂志,2017,23(8):18-22.
[5] Murray AC,Pasam R,Estrada D,et al.Risk of surgical site infection varies based on location of disease and segment of colorectal resection for cancer[J].Dis Colon Rectum,2016,59(6):493-500.
[6] 汪青,王雨,方俊,等.结直肠癌患者手术部位感染的病原菌分析[J].中华医院感染学杂志,2016,26(13):2930-2932.
[7] 傅华军,张少林,陈卉颖,等.结直肠癌术后切口感染与机体营养状态、免疫功能及炎性因子的关系[J].海南医学院学报,2017,23(7):921-924.
[8] Garland NY,Kheng S,De LM,et al.Using the WHO surgical safety checklist to direct perioperative quality improvement at a surgical hospital in Cambodia:the importance of objective confirmation of process completion[J].World J Surg,2017,41(12):3012-3024.
[9] Tsubouchi N,Fujibayashi S,Otsuki B,et al.Risk factors for implant removal after spinal surgical site infection[J].Eur Spine J,2017,27(10):2481-2490.
[10] Tabiri S,Yenli E,Kyere M,et al.Surgical site infections in emergency abdominal surgery at tamale teaching hospital,Ghana[J].World J Surg,2017,42(4):916-922.
[11] 王俊科,王多友,王凤学等译.美国麻省总医院临床麻醉手册[M].辽宁:辽宁科学技术出版社,2001:8-9.
[12] 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.
[13] Healy MA,Pradarelli JC,Krell RW,et al.Variation in primary site resection practices for advanced colon cancer:a study using the National Cancer Data Base[J].Am J Surg,2016,212(4):579-586.
[14] Napolitano F,Tomassoni D,Cascone D,et al.Evaluation of hospital readmissions for surgical site infections in Italy[J].Eur J Public Health,2017,28(3):421-425.
[15] Yao CM,Ziai H,Tsang G,et al.Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure[J].J Otolaryngol Head Neck Surg,2017,46(1):30.
[16] Badia JM,Casey AL,Petrosillo N,et al.Impact of surgical site infection on healthcare costs and patient outcomes:a systematic review in six European countries[J].J Hosp Infect,2017,96(1):1-15.
[17] Konstantelias AA,Andriakopoulou CS,Mourgela S.Triclosan-coated sutures for the prevention of surgical-site infections:a meta-analysis[J].Acta Chir Belg,2017,117(3):137-148.
[18] Benlice C,Stocchi L,Costedio MM,et al.Impact of the specific extraction-site location on the risk of incisional hernia after laparoscopic colorectal resection[J].Dis Colon Rectum,2016,59(8):743-750.
[19] Gupta N,Mathew J,Mohan H,et al.Addition of second-line steroid sparing immunosuppressants like mycophenolate mofetil improves outcome of Immunoglobulin G4-related disease (IgG4-RD):a series from a tertiary care teaching hospital in South India[J].Rheumatol Int,2018,38(2):203-209.
[20] Valizadeh N,Murray ACA,Suradkar K,et al.Impact of preoperative steroid or immunosuppressant use on short - term outcomes following colectomy in Crohn's disease patients[J].Tech Coloproctol,2017,21(3):217-223.
[21] 李黎,周安朋.医院不同病区细菌感染的分布及药敏分析[J].转化医学电子杂志,2016,3(2):82-83.
[22] Prin M,Guglielminotti J,Mtalimanja O,et al.Emergency-to-elective surgery ratio:a global indicator of access to surgical care[J].World J Surg,2017,42(7):1971-1980.
[23] Costa G,Lorenzon L,Massa G,et al.Emergency surgery for colorectal cancer does not affect nodal harvest comparing elective procedures:a propensity score-matched analysis[J].Int J Colorectal Dis,2017,32(10):1453-1461.