摘要
目的探讨克罗恩病(CD)手术部位感染(SSIs)的危险因素及病原菌分布。方法回顾性分析2015年7月至2018年7月浙江大学医学院附属邵逸夫医院手术治疗的379例CD患者临床资料,分析SSIs发生率及危险因素,取切口分泌物和腹腔引流液行细菌鉴定及药敏试验。结果本组379例患者发生66例SSIs,切口感染41例,腹腔深部感染32例。多因素分析显示术前使用类克(OR 2.338,95%CI 1.192~4.587,P=0.013)、外周血白细胞计数(OR 2.008,95%CI 1.018~3.961,P=0.044)及腹腔镜手术(OR 0.460,95%CI 0.226~0.936,P=0.013)是发生SSIs的独立预测因素。66例SSIs中检出病原菌59株,其中革兰阴性菌36株,革兰阳性菌5株,真菌2株。革兰阴性菌主要为大肠埃希菌、肺炎克雷伯菌等,对氨苄西林、头孢唑啉、环丙沙星等具有较高耐药率;革兰阳性菌主要为粪肠球菌和鸟肠球菌,对克林霉素、红霉素、庆大霉素等具有较高耐药率。62.1%培养细菌为广谱β内酰胺酶阳性,37.9%为广谱β内酰胺酶阴性。结论CD术后SSIs发生率较高,术前使用类克、外周血白细胞计数及腹腔镜手术是术后发生SSIs的预测因素。
Objective To analyze the risk factors for postoperative surgical site infections(SSIs)in patients with Crohn's disease(CD).Methods This retrospective observational study included CD patients undergoing bowel resection between July 2015 and July 2018.The prevalence and risk factors of SSIs were evaluated.The microbiological evaluation from patients with SSIs was performed by bacterial culture and drug sensitivity test.Results There were 66 patients suffering SSIs,with 41 incisional SSIs and 32 organ/space SSIs.Multivariate analysis identified the preoperative infliximab therapy(OR 2.338,95%CI 1.192-4.587,P=0.013),laparoscopic surgery(OR 0.460,95%CI 0.226-0.936,P=0.013),and preoperative white blood cell(OR 2.008,95%CI 1.018-3.961,P=0.044)as independent factors for SSIs.Fifty-nine strains of pathogenic bacteria were detected in 66 cases of CD combined with SSIs,including 36 strains of gram-negative bacteria,5 strains of gram-positive bacteria,and 2 strains of fungi.Escherichia coli and Klebsiella pneumoniae were main G-bacteria,with high resistance to common used antibiotics.Enterococcus faecalis and Enterococcus faecium were main G-.62.1%of the SSIs grew extended-spectrum β-lactamase(ESBL)-producing pathogens in their bacteria cultures and 37.9%grew non-ESBL microbes.Conclusion The incidence of SSIs was higher in CD patients.Preoperative infliximab therapy,preoperative white blood cell,and laparoscopic surgery were predictors of SSIs.
作者
葛晓龙
戚卫林
刘威
徐海利
叶玲娜
曹倩
周伟
Ge Xiaolong;Qi Weilin;Liu Wei;Xu Haili;Ye Lingna;Cao Qian;Zhou Wei(Department of General Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou,310016 China)
出处
《中华普通外科杂志》
CSCD
北大核心
2021年第7期520-524,共5页
Chinese Journal of General Surgery
基金
国家自然科学基金(81800474)。
