结直肠癌手术部位感染危险因素及预测模型

目的分析结直肠癌患者手术部位感染(SSI)的特点,建立预测模型并验证。方法选取2017年4月-2020年5月结直肠癌外科手术患者85例,分为SSI感染组(n=18)、未感染组(n=67),比较两组临床资料,分析SSI危险因素并建立预测模型,进行验证。结果18例SSI患者共检出病原菌27株,其中革兰阴性菌(18株)以大肠埃希菌为主,革兰阳性菌(8株)以金黄色葡萄球菌为主;大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌对氨苄西林、第三代头孢、四环素、氧氟沙星耐药率较高,对亚胺培南耐药率低,金黄色葡萄球菌对阿莫西林、头孢噻肟、阿米卡星均耐药;年龄、体质量指数(BMI)、合并糖尿病、Dukes分期、手术时间、手术类型、手术切口类型为结直肠癌患者术后发生SSI的独立危险因素,而术前白蛋白水平、补充益生菌为保护因素(P<0.05);经Logistic回归得到的9个相关因素建立SSI预测模型,其预测SSI的接受者工作特征曲线(ROC)下面积为0.869,该模型SSI预测值与实际发生率比较,无统计学差异。结论结直肠癌患者术后发生SSI易受较多因素影响,且SSI感染病原菌以大肠埃希菌、金黄色葡萄球菌为主,经多因素分析结果建立的预测模型有较好符合度,对筛选结直肠癌术后发生SSI高危人群有一定参考价值。

Risk factors for surgical site infection in colorectal cancer patients and establishment of prediction model

OBJECTIVE To analyze the characteristics of surgical site infection(SSI)in the patients with colorectal cancer and establish the prediction model for verification.METHODS Totally 85 patients with colorectal cancer who underwent surgeries from Apr 2017 to May 2020 were enrolled in the study and divided into the SSI group with 18 cases and the non-infection group with 67 cases.The risk factors for SSI were analyzed,the prediction model was established for verification.RESULTS A total of 27 strains of pathogens were isolated from 18 patients with SSI,18 of which were gram-negative bacteria,and 8 were gram-positive bacteria;Escherichia coli was dominant among the gram-negative bacteria;Staphylococcus aureus was the predominant species of the gram-positive bacteria.The E.coli,Klebsiella pneumoniae and Pseudomonas aeruginosa strains were highly resistant to ampicillin,third-generation cephalosporins,tetracycline and ofloxacin,while the drug resistance rates to imipenem were low;the S.aureus strains were resistant to amoxicillin,cefotaxime and amikacin.The age,body mass index(BMI),complication with diabetes mellitus,Dukes staging,operation duration,types of surgery and types of surgical incision were the independent risk factors for the postoperative SSI in the colorectal cancer patients,while the preoperative albumin level and supplementation of probiotics were protective factors(P<0.05).The prediction model for SSI was established based on 9 related factors that were acquired by logistic regression analysis,the area under receiver operating characteristic(ROC)curve of the model was 0.869 in prediction of SSI,and there was no significant difference between the prediction value of the model and the actual incidence of the infection.CONCLUSION There are a variety of influencing factors for the postoperative SSI in the colorectal cancer patients.E.coli and S.aureus are dominant among the pathogens causing SSI.The prediction model established based on the result of multivariate analysis has good conformity and certain reference value in screening of the population at high risk of postoperative SSI.