神经外科清洁手术术后颅内感染危险因素分析

目的探讨神经外科清洁手术术后颅内感染危险因素,为制定防控措施提供依据。方法回顾性分析2014年中山市中医院神经外科清洁手术术后颅内感染19例患者,用1∶5随机配对,与同期95例未发生感染者的临床资料进行病例对照研究,将各项危险因素量化后输入SPSS 16.0软件,先行单因素分析,再用logistic回归分析筛选主要危险因素。结果单因素分析显示:手术时间≥3h、术后使用抗菌药物≥4d、后颅窝手术、手术风险(NNIS)分级等级高,是术后颅内感染的危险因素。Logistic回归分析发现,术后使用抗菌药物≥4d(OR=3.84,P=0.034)、后颅窝手术(OR=9.44,P=0.038)是神经外科清洁手术术后颅内感染的独立危险因素。结论神经外科清洁手术术后应尽量缩短抗菌药物使用疗程,对后颅窝手术、手术时间长和NNIS评分高者,应积极采取预防措施。     

神经外科患者手术部位感染及危险因素

目的了解某三甲医院神经外科手术部位感染(SSI)发病率及其危险因素,为预防SSI提供理论依据。方法将该院神经外科2011年12月31日—2012年12月31日发生SSI的47例患者（共49例,其中2例未配比合适对照患者,故舍去）设为感染组,未发生SSI的94例患者（1∶2配比）设为非感染组,采用回顾性调查分析方法,对SSI相关危险因素进行分析。结果两组患者一般情况比较,差异均无统计学意义（均P＞0.05）;3 708例手术患者,发生SSI 49例,SSI发病率为1.32%;SSI以颅内感染为主(89.80%);49例SSI患者共27例行脑脊液细菌学检测,其中6例患者脑脊液细菌学检测阳性,病原菌检出率为22.22%。单因素条件logistic分析显示：手术风险评估分级（OR=2.04）、术前抗菌药物使用次数（OR=3.15）、术中抗菌药物使用次数（OR=2.58）、手术持续时间（OR=2.70）、术中失血量（OR=1.72）、留置引流管（OR=4.30）、术后置管持续时间（OR=2.06）及术后首次换药时间（OR=1.66）为神经外科SSI危险因素;多因素条件logistic回归分析显示：术前抗菌药物使用次数（P=0.03,OR=4.86）、手术持续时间（P=0.05,OR=2.89）及术后首次换药时间（P=0.01,OR=1.92）是SSI的独立危险因素。结论神经外科SSI危险因素多,手术持续时间、术后置管持续时间及术后首次换药时间是主要危险因素。     

气管插管全麻上腹部手术患者肺部感染风险分析

目的 探讨气管插管全麻的上腹部手术患者术后肺部感染的相关因素,降低全麻术后肺部感染发生率、提高麻醉安全.方法 选择医院实施气管插管全麻患者的临床资料624份,收集患者一般资料、麻醉资料及治疗资料,采用x2检验分析患者术后肺部感染的相关因素,采用多因素logistic回归分析肺部感染的独立影响因素.结果 624例气管插管全麻的上腹部手术患者术后肺部感染49例,肺部感染率为7.85％,单因素分析结果显示年龄(x2 =4.316,P=0.038)、体重指数(x2=6.113,P=0.013)、手术种类(x2=9.571,P=0.002)、插管时间(x2=12.49,P=0.000)、吸烟史(x2=20.197,P=0.000)是气管插管全麻上腹部手术术后肺部感染的相关因素,logistic回归分析显示手术种类(OR=6.014)、插管时间(OR=0.942)、吸烟史(OR=1.209)是气管插管全麻上腹部手术术后肺部感染的独立影响因素.结论 气管插管全麻上腹部手术患者术后肺部感染风险较高,麻醉前要给予充分评估,对危险因素加以干预,减少术后肺部感染的发生率.     

新疆某三级甲等医院2364例神经外科手术患者医院感染危险因素

目的 探讨神经外科手术患者医院感染发生的相关危险因素，为有效降低神经外科手术患者医院感染的发生提供理论依据。方法 回顾性调查2018-2021年新疆某三级甲等综合医院神经外科收治的手术患者中发生医院感染患者的一般情况、手术麻醉、医院感染和抗菌药物使用情况等，并采用logistic回归分析其危险因素。结果 2 364例神经外科手术患者中，发生医院感染227例，医院感染发病率为9.60%。感染部位以呼吸系统（121例，占45.32%）、手术部位（66例，占24.72%）、泌尿系统（32例，占11.99%）为主。单因素分析结果显示：合并糖尿病、合并高血压、术前低蛋白、术前住院天数、手术入路、美国麻醉师协会(ASA）评分、手术风险分级标准（NNIS）、手术类型、麻醉方式、手术持续时间、围手术期输血等差异有统计学意义(P<0.05)；多因素logistic回归分析结果显示:合并高血压(OR=1.582,95%CI:1.031～2.427)、术前低蛋白(OR=4.873,95%CI:3.213～7.390)、术前住院日数≥7 d(OR=4.291,95%CI:2.731～6.742)、幕下手...     

胃结肠手术部位感染相关危险因素研究

目的探讨胃结肠手术部位感染(SSI)的危险因素,为SSI的预防控制措施提供依据。方法采用目标性监测的方法,研究胃结肠手术后SSI的发生,采用SPSS 10.0软件对其相关危险因素,如术前住院日、血糖、外周血血浆白蛋白、术前发热、手术持续时间、手术方式、ASA评分、内镜使用、失血量、术后引流管放置天数、入住ICU等25个变量进行单因素和多元logistic回归分析。结果 502例胃结肠手术后SSI发生率为6.17%,其中住院期间感染24例,感染率为77.4%,出院后随访感染7例,感染率为22.6%;多元logistic回归分析显示,血糖异常(P=0.002)、手术持续时间长(P=0.000)、内镜使用(P=0.032)是SSI发生的主要危险因素。结论胃结肠SSI是多因素综合作用引起的,开展目标性监测加强对临床干预可促使医疗质量持续改进,降低SSI发生率。     

围手术期全麻术后患者发生肺部感染的危险因素分析

目的探讨围手术期全麻术后患者发生肺部感染的危险因素。方法回顾性分析2014年1月-2017年6月本院手术室接受全麻术的围手术期326例患者的临床资料。根据患者是否发生肺部感染,分为感染组35例和未感染组291例,采用Logistic回归分析确定患者发生肺部感染的危险因素。结果 326例围手术期全麻术后患者发生肺部感染35例,感染率为10.7%;痰液培养28株病原菌,Logicstic回归分析显示,有COPD史、钠石灰更换频率1次/d、麻醉时间≥3 h及拔管时间延迟≥3 h是围手术期全麻术后患者发生肺部感染的独立危险因素(P0.05),有COPD病史患者表现出更高肺部感染风险(OR=4.648,95%CI:2.246~9.618,P0.05)。结论围手术期全麻术后患者发生肺部感染危险因素较多,临床应针对相关危险因素采取预防措施,以降低围手术期全麻术后患者发生肺部感染的发生率。     

体外循环心脏术后肺部感染的危险因素及其预测模型

目的 分析体外循环心脏术后肺部感染的危险因素及其预警模型。方法 选择2021年1月-2022年12月于某三甲医院ICU完成体外循环心脏手术的172例患者展开回顾性分析,依据患者术后肺部感染情况分为感染组(n=41)和对照组(n=131);采用多因素Logistic回归分析归纳体外循环心脏术后肺部感染的危险因素,构建多因素联合应用的预警模型,总结感染组患者病原菌情况。结果 糖尿病、体外循环时间、美国麻醉师协会(ASA)分级为体外循环心脏术后患者发生肺部感染的危险因素,淋巴细胞(LYM)是保护因素(P<0.05);由危险因素构建的Log(P)预警模型,对体外循环心脏术后患者发生肺部感染的预警效能较高,受试者工作特征曲线下面积(ROC-AUC)(0.95CI)为0.884(0.769～0.969);感染组患者的病原菌以革兰阴性菌(70.59%)为主,其中鲍氏不动杆菌(36.76%)为主要菌株。结论 糖尿病、体外循环时间、ASA分级Ⅲ～Ⅳ级是体外循环心脏术后肺部感染的危险因素,LYM为保护因素,临床应对高危患者加强监测和预警,并及时依据感染菌株给予抗菌药物治疗,以改善患者预后。     

开颅手术患者手术后肺炎的危险因素

目的探讨开颅患者手术后肺炎的危险因素及其预防策略。方法回顾性调查2014年1月—2015年12月某大型教学医院神经外科行开颅手术患者的病历资料。调查内容包括一般资料、手术情况及手术后肺炎发生情况等。分析开颅手术患者手术后肺炎的危险因素。结果共调查880例开颅手术后患者,发生手术后肺炎178例,发病率为20.23%。单因素分析结果显示年龄越大、术前合并基础疾病、ASA分级为Ⅲ-Ⅳ级、失血量大、手术持续时间长、术前住院日数长、术中输血、留置胃管、机械通气时间≥4 h、有气管切开、急诊手术的患者手术后肺炎的发病率较高,差异具有统计学意义(均P0.05)。非条件多因素logistic回归分析显示6个变量为手术后肺炎的独立危险因素,按OR值从大至小排序依次为气管切开[OR=27.73,95%CI(2.49～30.83)]、术后留置胃管[OR=4.55,95%CI(2.54～8.16)]、急诊手术[OR=4.34,95%CI(1.49～12.63)]、机械通气时间[OR=2.81,95%CI(1.37～5.75)]、术前住院时间[OR=1.06,95%CI(1.02～1.10)]、年龄[OR=1.03,95%CI(1.01～1.04)]。结论开颅手术患者手术后肺炎发病率高,应针对其危险因素采取有效防控措施,降低其感染率。     

气管插管全麻术后医院内肺部感染的危险因素分析

目的探讨气管插管全麻手术后,引起医院内肺部感染的危险因素。方法回顾性分析2006年6月-2010年9月,医院气管插管全麻手术后,引起医院内肺部感染121例患者的临床资料,选取影响肺部感染相关因素进行logistic回归分析。结果年龄>60岁、长期吸烟史、开胸手术、全身麻醉时间>4 h、无术后镇痛、术后气管导管留置时间>2 h的患者,术后肺部感染发生率明显增高,与组内比较,差异有统计学意义(P<0.05);多因素分析表明,年龄>60岁(P=0.000,R=4.317)、长期吸烟史(P=0.003,R=2.226)、开胸手术(P=0.000,R=12.813)、全身麻醉时间>4 h(P=0.046,R=2.634)、无术后镇痛(P=0.032,R=2.419)、术后气管导管留置时间>2 h(P=0.000,R=1.486)是术后肺部感染独立影响因素。结论气管插管全麻手术后,医院内肺部感染和多种因素有关,年龄>60岁、长期吸烟史、开胸手术、全身麻醉时间>4 h、无术后镇痛、术后气管导管留置时间>2 h为术后肺部感染的独立因素,对上述因素干预有助于医院内肺部感染的预防与控制。     

肝胆手术后切口感染原因分析及防治对策

目的 总结分析肝胆手术后切口感染的原因和防治对策.方法 回顾性分析460例肝胆手术后切口感染的危险因素,包括患者因素和手术操作因素,并提出相应的防治对策.结果 460例肝胆外科开腹手术患者,术后发生切口感染90例占19.6％;术后发生切口感染的危险因素依次是肥胖(OR=8.89,P＜0.01)、切口类型(OR=7.22,P＜0.01)、手术时间(OR=6.50,P＜0.01)、术中失血量(OR=6.03,P＜0.05)、糖尿病(OR=4.12,P＜0.01)、患者年龄(OR=3.97,P＜0.05).结论 手术中严格执行无菌操作、保证手术环境卫生、加强术后切口的护理、合理使用抗菌药物,可降低肝胆疾病术后切口感染的发生率.     

Nosocomial infection, indices of intrinsic infection risk, and in-hospital mortality in general surgery

The objectives of this paper are to assess whether two indices of intrinsic infection risk (the SENIC and the NNIS index) predict in-hospital mortality and the attributable in-hospital mortality due to nosocomial infection in surgical patients. A prospective study on 4714 patients admitted to three hospitals has been carried out. The relative risk and its 95% confidence interval (CI) were estimated. Multiple-risk factors adjusted for odds ratios (OR) were yielded by logistic regression analysis. Overall, 119 patients (2.5%) died before hospital discharge. Both the SENIC and the NNIS indices were related to in-hospital mortality in crude data. After controlling for several variables (age, sex, ASA score, cancer, renal failure, diabetes mellitus, stay at the ICU), the SENIC index did not show any significant trend with mortality (P = 0.252), whereas the trend was significant for the NNIS index (P < 0.001). Risk of death in patients with one nosocomial infection was 7.5%, and in patients developing more than one nosocomial infection was 17.1%. After adjusting for several confounding variables, the development of an organ/space surgical site infection was significantly related to mortality (OR = 4.5, 95% CI 1.5-15.6) as was blood infection (OR = 17.3, 95% CI 3.5-87.0). The association of a surgical site infection and either a respiratory tract infection or a blood infection also increased significantly the risk of in-hospital mortality (OR = 3.3, 95% CI 1.2-8.7). In conclusion, the NNIS index is a good predictor of in-hospital mortality. Patients developing an organ/space surgical site infection and/or a blood infection have an increased risk of in-hospital mortality.     

Incidence of surgical-site infections and the validity of the National Nosocomial Infections Surveillance System risk index in a general surgical ward in Santa Cruz, Bolivia.

OBJECTIVES: To estimate the frequency of and risk factors for surgical-site infections (SSIs) in Bolivia, and to study the performance of the National Nosocomial Infections Surveillance (NNIS) System risk index in a developing country. DESIGN: A prospective study with patient follow-up until the 30th postoperative day. SETTING: A general surgical ward of a public hospital in Santa Cruz, Bolivia. PATIENTS: Patients admitted to the ward between July 1998 and June 1999 on whom surgical procedures were performed. RESULTS: Follow-up was complete for 91.5% of 376 surgical procedures. The overall SSI rate was 12%. Thirty-four (75.6%) of the 45 SSIs were culture positive. A logistic regression model retained an American Society of Anesthesiologists score of more than 1 (odds ratio [OR], 1.87), a not-clean wound class (OR, 2.28), a procedure duration of more than 1 hour (OR, 1.81), and drain (OR, 1.98) as independent risk factors for SSI. There was no significant association between the NNIS System risk index and SSI rates. However, a "local" risk index constructed with the above cutoff points showed a linear trend with SSI (P < .001) and a relative risk of 3.18 for risk class 3 versus a class of less than 3. CONCLUSIONS: SSIs cause considerable morbidity in Santa Cruz. Appropriate nosocomial infection surveillance and control should be introduced. The NNIS System risk index did not discriminate between patients at low and high risk for SSI in this hospital setting, but a risk score based on local cutoff points performed substantially better.     

异位妊娠患者术后院内感染病原菌特征及危险因素分析

目的 探讨异位妊娠患者术后医院内感染病原菌特征并分析引发感染的危险因素。方法 选取2018年1月 - 2020年4月在我院接受异位妊娠手术患者260例,收集异位妊娠患者临床资料并统计患者术后院内感染情况,采集术后院内感染患者血液、尿液等临床标本,培养并鉴定病原菌分布情况,采用单因素与多因素logistic分析影响其院内感染的危险因素。结果 260例异位妊娠手术患者中有23例发生院内感染,感染率为8.85%,23例患者共分离出病原菌31株,其中革兰阳性菌17株（54.84%）,革兰阴性菌10株（32.26%）,真菌4株（6.45%）;经单因素分析显示:伴有其他基础疾病（χ2 = 12.496,P＜0.001）、手术时间≥2 h（χ2 = 11.782,P = 0.001）、术中出血量≥100 ml（χ2 = 6.779,P = 0.009）、住院时间≥2周（χ2 = 6.052,P = 0.014）、术后留置导管（χ2 = 7.856,P = 0.005）及卧床时间≥4周（χ2 = 5.426,P = 0.020）等因素是影响异位妊娠患者术后院内感染的因素;经多因素logistic分析显示:伴有其他基础疾病（OR = 4.860,95%CI:1.456～16.219,P = 0.010）、术后留置导管（OR = 48.777,95%CI:7.502～317.155,P＜0.001）、手术时间≥2 h（OR = 9.325,95%CI:2.035～42.725,P = 0.004）及住院时间≥2周（OR = 24.559,95%CI:3.394～177.695,P = 0.002）是患者术后院内感染的独立危险因素。结论 异位妊娠患者术后院内感染主要病原菌为革兰阳性菌,伴有其他基础疾病、术后留置导管、手术及住院时间过长等均为引发患者出现术后感染的重要危险因素。     

呼吸机相关性肺炎假丝酵母菌属感染的危险因素及预后分析

目的探讨机械通气患者呼吸机相关性肺炎假丝酵母菌属感染危险因素的差异及影响预后的因素。方法回顾性分析医院114例机械通气48h的患者,将其中50例呼吸机相关性肺炎假丝酵母菌属感染者分为早发型感染组和迟发型感染组,以非假丝酵母菌属感染者为对照组,采用单因素(χ2检验)及多因素Logistic回归进行统计学分析;将感染组以死亡病例为病例组,以非死亡病例为对照组进行死亡危险因素χ2分析。结果频繁更换抗菌药物(OR=5.828,P=0.001)、患2种基础疾病(OR=4.538,P=0.008)是早发型感染的独立危险因素;高龄(OR=5.684,P=0.000)、血白蛋白25g(OR=2.279,P=0.000)是迟发型感染的独立危险因素;预防性抗真菌治疗(OR1=0.064,P1=0.004;OR2=0.561,P2=0.014)是两者的保护性因素;昏迷(P=0.001)、肾功能异常(P=0.002)、患2种基础疾病(P=0.026)是影响预后的危险因素。结论早发型和迟发型呼吸机相关性肺炎假丝酵母菌属感染危险因素是有差异的,及时发现感染和影响预后的危险因素,采取针对性措施,有助于改善机械通气患者的预后。     

Relationship between nosocomial infection and mortality in a neurology intensive care unit in Turkey

Few previous studies have evaluated the relationship between nosocomial infection and mortality in a neurology intensive care unit (ICU). In this study, patients treated for more than 24h in the neurology ICU of the Ankara Training and Research Hospital, Turkey were followed until death or two days after discharge by prospective daily surveillance. The study period was 14 months. One hundred and sixty-nine ICU-acquired infections occurred in 74 (38.9%) of 190 patients during 2006 patient-days. The overall rate of ICU-acquired nosocomial infection was 88.9/100 patients and 84.2/1000 patient-days. While the overall mortality rate was 60%, mortality in patients with nosocomial infections was 69%. In univariate analysis, infection (nosocomial and community-acquired) (P=0.002), nosocomial infection (P<0.05), mechanical ventilation (P<0.0001), presence of two or more underlying diseases (P=0.01), parenteral nutrition (P<0.0001), steroid treatment (P=0.003) and a low Glasgow Coma Scale (GCS) score (P=0.0001) were identified as risk factors for mortality. Stepwise logistic regression analysis showed nosocomial infection (P<0.05), mechanical ventilation (P=0.009), the presence of two or more underlying diseases (P<0.05) and a low GCS score (P=0.0001) to be risk factors for ICU mortality. It was concluded that nosocomial infection increases the risk of mortality by a factor of 1.69. The impact of nosocomial infection on mortality in our ICU was higher in patients with high GCS scores and patients aged between 66 and 75 years. In particular, nosocomial infection increased mortality among patients with less severe illnesses.     

Active surveillance of nosocomial infections in heart surgery patients: implementation of the American National Nosocomial Infections Surveillance (NNIS) System in a large hospital in Rome

The authors present the implementation of the American NNIS System method for active surveillance in the heart surgery and its intensive care unit (ICU) of a large hospital in Rome (almost 1.000 beds). This surveillance was based on full time infection control professionals. Device-associated infection rates were calculated for adult ICU surveillance component. For surgical patient surveillance component we used the surgical site infection (SSI) risk index based on wound class, duration of operation and American Society of Anesthesiology score. The NNIS System method allowed us to understand the most relevant problems in heart surgery patients: in comparison with NNIS data, we found high rates of SSIs both in procedures on valves and in coronary artery bypass grafts. The central line-associated bloodstream infection rate was higher than the American median rate. Therefore, we decided to focus on surgical risk factors linked to SSIs and to revise recommendations for intravascular-device use. In conclusion, in our experience the NNIS System method proved to be a very useful and versatile tool for nosocomial infections active surveillance.     

ICU住院患者医院感染及危险因素分析

目的 探讨ICU住院患者并发医院感染的发生率及其相关危险因素,提出预防ICU医院感染的对策.方法 对1314例ICU住院患者进行回顾性调查,根据医院感染诊断标准将其分为感染组(139例)和未感染组(1175例);分析ICU住院患者的医院感染率,采用单因素χ2检验、多因素逐步Logistic回归法来筛选ICU住院患者并发...     

Usefulness of intrinsic surgical wound infection risk indices as predictors of postoperative pneumonia risk

The main objective of this report was to use two indices of intrinsic surgical wound infection risk, the SENIC index (Haley et al., 1985) and the NNIS index (Culver et al., 1991), to predict risk of postoperative pneumonia in general surgery patients. A prospective cohort study on 1483 patients admitted under the general surgery speciality of a tertiary hospital was performed. The main outcome measure was postoperative pneumonia. Relative risk and their 95% confidence intervals (CIs) were estimated. Stepwise logistic regression analysis was used to select the main determinant predictors. During follow-up, 19 (1·3%) patients acquired postoperativepneumonia. Common risk factors of postoperative pneumonia were identified: mechanical ventilation, age, upper abdominal surgery, severity of illness, obesity, hypoalbuminaemia, and use of histamine type 2 receptor antagonists. Both the SENIC and the NNIS indices showed a statistically significant association (P < 0·001) with postoperative pneumonia risk: the higher the score the greater the risk. Stepwise logistic regression analysis selected five variables: (1) mechanical ventilation [odds ratio (OR) = 9·8, 95% CI 2·7–35·6]; (2) upper abdominal surgery (OR = 4·7, 95% CI 1·6–13·9); (3) chronic lung disease (OR = 5·9, 95% CI 1·7–21·2); (4) the NNIS index (OR for each POINT = 2·2, 95% CI 1·1–4·4); and (5) obesity, measured by a body mass index greater than the 90th percentile (OR = 2·9, 95%, CI 0·9–9·4). In conclusion, both the SENIC and the NNIS indices were related to postoperative pneumonia risk. The NNIS index may be a better predictor.     

Risk factors for surgical-site infection following primary total knee arthroplasty.

OBJECTIVE: To identify risk factors associated with the development of surgical-site infection (SSI) following total knee arthroplasty (TKA). DESIGN: A case-control study. SETTING: A 1,100-bed, university-affiliated, tertiary-care teaching hospital. METHODS: Case-patients with SSI occurring up to 1 year following primary TKA performed between January 1999 and December 2001 were identified prospectively by infection control practitioners using National Nosocomial Infections Surveillance (NNIS) System methods. Three control-patients were selected for each case-patient, matched by date of surgery. Stepwise logistic regression analysis was used to determine the relation of potential risk factors to the development of infection. RESULTS: Twenty-two patients with infections (6 superficial and 16 deep) were identified. Infection rates per year were 0.95%, 1.07%, and 1.19% in 1999, 2000, and 2001, respectively. Logistic regression analysis identified two variables independently associated with the development of infection: the use of closed suction drainage (odds ratio [OR], 7.0; 95% confidence interval [CI95], 2.1-25.0; P = .0015) and increased international normalized ratio (INR) (OR, 2.4; CI95, 1.1-5.7; P = .035). Factors not statistically associated with the development of infection included age, NNIS System risk index score, presence of various comorbidities, surgeon, duration of procedure or tourniquet time, type of bone cement or prosthesis used, or receipt of blood product transfusions. CONCLUSIONS: The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA. Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection.