101例人类免疫缺陷病毒感染者行外科手术后创口感染情况回顾性分析

目的分析2009-01/2018-12间在西南医科大学附属医院行外科手术的人类免疫缺陷病毒(HIV)感染者术后创口感染情况,为降低HIV感染者术后创口感染的风险、针对性地实施围手术期的处理及护理提供参考依据。方法回顾性收集2009-01/2018-12间在西南医科大学附属医院行外科手术治疗的HIV/AIDS病例患者相关临床资料和实验室检查结果,采用卡方检验和多因素风险回归法对数据进行统计分析。结论2009-01/2018-12间在西南医科大学附属医院行外科手术HIV/AIDS病例共101例,术后发生创口感染46例,感染率为45.54%。病原菌培养显示,大肠埃希菌16例(34.78%),肺炎克雷伯菌7例(15.22%),变异奇形杆菌5例(10.87%),金黄色葡萄球菌8例(17.39%),链球菌4例(8.70),其他6例(13.04%)。单因素分析显示,术后创口感染率在不同年龄、切口类型、术前CD4^+T细胞水平和HIV感染临床分期等方面均存在统计学差异(P<0.05)。多因素分析显示,切口类型为Ⅱ类(OR:1.45,95%CI:1.21~2.01)和Ⅲ类(OR:1.55,95%CI:1.17~2.09)、HIV感染临床分期为艾滋病期(OR:1.32,95%CI:1.19~1.72)者其术后发生创口感染的风险增高(P<0.05),术前CD4^+T细胞水平≥200个/mm^3者(OR:0.65,95%CI:0.46~0.76)其术后发生创口感染的风险较低(P<0.05)。结论西南医科大学附属医院HIV/AID行外科手术后创口感染率较高,需引起重视,感染的病原菌种类多且以大肠埃希菌为主,影响创口感染的因素较多,需针对性地采取围术期防治措施以减少HIV感染者外科后的创口感染。

Retrospective Analysis on the Wound Infection After Surgery of 101 Human Immunodeficiency Virus-Infected Patients

Objective To analyze the postoperative wound infection in the human immunodeficiency virus(HIV)-infected patients who underwent surgery in the Affiliated Hospital of Southwest Medical University from January 2009 to December 2018,so as to provide references for reducing the risk of postoperative wound infection in the patients infected with HIV and providing targeted perioperative management and care.Method In February 2019,the clinical data and laboratory test results of HIV/AIDS patients who underwent surgical treatment in Affiliated Hospital of Southwest Medical University from January 2009 to December 2018 were retrospectively collected,and the Chi-square test and multivariate risk regression method were used for statistical analysis.Results A total of 101 cases of HIV-infected patients were involved in this study,and 46 cases of wound infection occurred postoperatively,with an infection rate of 45.54%.Pathogen culture showed that 16 cases(34.78%)were escherichia coli,7 cases(15.22%)were klebsiella pneumoniae,5 cases(10.87%)were mutant,8 cases(17.39%)were staphylococcus aureus,4 cases(8.70)were streptococcus,and 6 cases(13.04%)were other bacteria.Univariate analysis indicated that there were statistically significant differences in postoperative wound infection rate in different ages,incision types,level of CD4^+T cell and HIV staging before operation(P<0.05).Multi-factor analysis showed the patients with classⅡtype incision(OR:1.45,95%CI:1.21~2.01)and classⅢincision type(OR:1.55,95%CI:1.17~2.09)andⅢstage of HIV infection(OR:1.32,95%CI:1.19~1.72)had higher risk of postoperative wound infection(P<0.05),and the patients with preoperative level of CD4^+T cell≥200 cells/mm^3(OR:0.65,95%CI:0.46~0.76)had lower the risk of postoperative wound infection(P<0.05).Conclusion The wound infection rate of HIV-infected patients in the Affiliated Hospital of Southwest Medical University is relatively high,which needs to be paid more attention.There are many pathogenic bacteria in the infection and mainly escherichia coli.As the factors affecting wound infection are too many,it is necessary to take specific perioperative prevention and control measures to reduce the postoperative wound infection in HIV-infected patients.