中国多中心前瞻性研究 3663 例连续患者结直肠手术后手术部位感染的发生率和危险因素。

Incidence of and risk factors for surgical site infection after colorectal surgery: A multiple-center prospective study of 3,663 consecutive patients in China.

机构信息

Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Nosocomial Infection Control and Quality Improvement Center, China.

Department of Laboratory, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China.

出版信息

Int J Infect Dis. 2020 Jul;96:676-681. doi: 10.1016/j.ijid.2020.05.124. Epub 2020 Jun 4.

DOI:10.1016/j.ijid.2020.05.124

PMID:32505873

Abstract

BACKGROUND

Surgical site infection (SSI) after colorectal surgery (CRS) remains a significant problem for its negative clinical outcomes. However, it is poorly understood in China. This study aims to investigate the incidence, risk factors and microbiology of SSI after CRS.

METHODS

A nationwide prospective multicenter design was applied. Patients in 19 Chinese hospitals from 2015 to 2018 were prospectively monitored for SSI after CRS. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using univariate and multivariate logistic regression models.

RESULTS

Among 3,663 study participants, 134(3.66%) episodes of SSI were identified. The incidence rate of SSI decreased from 5.9 infections per 100 procedures in 2015 to 3.1 infections per 100 procedures in 2018 (incidence rate ratio, 0.52; 95% CI, 0.28-0.94). The SSI rates were 1.88, 4.15, 6.27 and 11.58 per 100 operations for the National Nosocomial Infections Surveillance system (NNIS) risk index categories of 0, 1, and 2 or 3, respectively. Escherichia coli (54/134, 40.3%) and Klebsiella pneumoniae (10/134, 7.5%) were the most frequently isolated microorganisms. A high prevalence of antibiotic resistance were observed in our study, with rates of extended spectrum beta-lactamase-producing or carbapenem-resistant Escherichia coli and Klebsiella pneumonia of 50.0%(27/54) and 30.0%(3/10) respectively. Preoperative hospital stay ≥ 48h (OR=2.28, 95% CI: 1.03-5.02, P=0.042) and contaminated or dirty wound (OR=3.38, 95% CI: 1.88-6.06, P=4.50×10) were significantly associated with increasing risk of SSI after CRS.

CONCLUSION

A statistically significant but modest decrease in the incidence rate of CRS SSI over the 4-year study period was observed in this study. Noticeably, the relatively high rates of multidrug-resistant pathogens causing SSI after CRS should be alert, while more studies with large population are needed due to the small number of isolates identified in our survey.

摘要

背景

结直肠手术后（CRS）的手术部位感染（SSI）仍然是一个严重的临床问题，因为它会产生负面的临床后果。然而，中国对其了解甚少。本研究旨在调查 CRS 后 SSI 的发生率、危险因素和微生物学情况。

方法

采用全国前瞻性多中心设计。2015 年至 2018 年，19 家中国医院的患者前瞻性监测 CRS 后的 SSI。收集和分析人口统计学数据、医院特征和潜在围手术期危险因素，采用单因素和多因素逻辑回归模型。

结果

在 3663 名研究参与者中，发现 134 例（3.66%）SSI 发作。SSI 的发生率从 2015 年每 100 例手术 5.9 例感染降至 2018 年每 100 例手术 3.1 例感染（发生率比，0.52；95%可信区间，0.28-0.94）。根据国家医院感染监测系统（NNIS）风险指数类别，SSI 发生率分别为 0、1、2 或 3，每 100 例手术分别为 1.88、4.15、6.27 和 11.58。大肠埃希菌（54/134，40.3%）和肺炎克雷伯菌（10/134，7.5%）是最常分离的微生物。在本研究中观察到抗生素耐药率较高，产超广谱β-内酰胺酶或碳青霉烯类耐药的大肠埃希菌和肺炎克雷伯菌分别为 50.0%（27/54）和 30.0%（3/10）。术前住院时间≥48h（OR=2.28，95%CI：1.03-5.02，P=0.042）和污染或脏伤口（OR=3.38，95%CI：1.88-6.06，P=4.50×10）与 CRS 后 SSI 的风险增加显著相关。