基于Joinpoint回归模型的上海市某区级综合医院手术部位感染趋势分析

目的了解2016—2023年上海市某区级综合医院手术部位感染监测数据的时间变化趋势,为开展医院感染防控工作提供参考依据。方法通过《医院感染实时监控系统》收集并整理2016—2023年的手术部位感染监测数据,并采用Joinpoint回归模型分析其时间变化趋势,计算其年度变化百分比（annual percent change, APC）和平均年度变化百分比（average annual percent change, AAPC）。结果2016—2023年上海市某区级综合医院普外科、骨科及全院的平均手术部位感染率分别为1.67%、0.85%和0.55%,手术部位感染率分别从2016年的2.97%、2.06%和0.92%下降至2023年的0.91%、0.43%和0.31%。Joinpoint回归模型分析结果显示,2016—2023年全院的手术部位感染率AAPC为-17.50%（95%CI: -24.75%~-9.55%）,普外科和骨科分别为-17.68%（-25.85%~-8.62%）和-24.18%（-30.65%~-17.10%）,三组的手术部位感染率均呈显著下降趋势（P＜0.05）,其中,2016—2020年骨科手术部位感染率以每年30.99%（APC 95%CI: -44.76%~-13.79%）的速度下降（Z=5.30,P=0.013）。2016—2023年期间,手术部位感染的病原学送检标本中共分离病原菌477株,前6位依次为大肠埃希菌（26.00%）、金黄色葡萄球菌（16.35%）、肠球菌（13.21%）、肺炎克雷伯菌（9.64%）、铜绿假单胞菌（8.60%）和鲍曼不动杆菌（5.03%）。其中,肺炎克雷伯菌的占比以33.31%的速度上升（AAPC 95%CI: 8.44%~63.89%）,且趋势变化具有统计学意义（Z=2.73,P=0.006）。结论2016—2023年上海市某区级综合医院的手术部位感染率呈显著下降趋势,医院感染防控成效显著,但仍需重点加强围术期的全过程精细化管理。

Trend analysis of surgical site infections in a Shanghai district general hospital based on Joinpoint regression model

ObjectiveTo investigate the trend of surgical site infections in a district general hospital in Shanghai from 2016 to 2023. MethodsThe data of surgical site infections from 2016 to 2023 were collected and sorted through the Real-time Hospital Infection Monitoring System.The annual percentage change(APC) and average annual percentage change(AAPC) were calculated by Joinpoint regression model to analyze the time trend. ResultsFrom 2016 to 2023, the average surgical site infection rates in Departments of General Surgery, Orthopedics and the whole hospital were 1.67%, 0.85% and 0.55%, which were decreased from 2.97%, 2.06% and 0.92% in 2016 to 0.91%, 0.43% and 0.31% in 2023, respectively. The results of Joinpoint regression model analysis showed that the AAPC of surgical site infection rates from 2016 to 2023 were -17.50%(95%CI: -24.75%--9.55%) in the whole hospital, -17.68%(-25.85%--8.62%) in general surgery department and -24.18%(-30.65%--17.10%) in orthopedics department, respectively(all P<0.05). From 2016 to 2020, the rate in orthopedics decreased by 30.99%(APC 95%CI: -44.76%--13.79%) per year(Z=5.30, P=0.013). From 2016 to 2023, a total of 477 strains of pathogenic bacteria were isolated from the specimens of surgical site infection. The top 6 pathogens were Escherichia coli(26.00%), Staphylococcus aureus(16.35%), Enterococcus(13.21%), Klebsiella pneumoniae(9.64%), Pseudomonas aeruginosa(8.60%) and Acinetobacter baumannii(5.03%). The proportion of Klebsiella pneumoniae increased with a rate of 33.31%(AAPC 95%CI: 8.44%-63.89%), and the change trend was statistically significant(Z=2.73, P=0.006). ConclusionFrom 2016 to 2023, the surgical site infection rate of a district general hospital in Shanghai shows a significant decline trend, indicating that the nosocomial infection prevention and control effect is remarkable, but the meticulous management of the whole perioperative period still needs to be strengthened.