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。

Characteristics and risk factors of nosocomial infection pathogens in patients with ectopic pregnancy

To explore the characteristics of nosocomial infection pathogens in patients with ectopic pregnancy, and to analyze the risk factors of infection. Methods 260 patients who had undergone ectopic pregnancy surgery in our hospital from Jan. 2018 to Apr. 2020 were selected. The clinical data of patients with ectopic pregnancy were collected, and the postoperative nosocomial infections of patients were counted. The clinical samples of postoperative nosocomial infected patients’ blood and urine were collected, and the distribution of pathogens was identified after they were cultured. Univariate Logistic Regression and Multivariate Logistic Regression were used to analyze the risk factors of nosocomial infection.Results Nosocomial infection occurred in 23 out of the 260 patients with ectopic pregnancy, with the infection rate of 8.85%.A total of 31 pathogenic bacteria were isolated from 23 patients, including 17 Gram-positive bacteria(54.84%), 10 Gramnegative bacteria(32.26%), and 4 fungi(6.45%). Univariate Logistic Regression showed that the factors such as other basic diseases(χ2=12.496, P<0.001), operation time ≥2 h(χ2=11.782, P=0.001), intraoperative blood loss ≥100 ml(χ2=6.779, P=0.009), hospital stay ≥2 weeks(χ2=6.052, P=0.014), postoperative indwelling catheters(χ2=7.856, P=0.005), and bedtime ≥4 weeks(χ2=5.426, P =0.020) were risk factors for postoperative nosocomial infection in patients with ectopic pregnancy.Multivariate Logistic Regression showed that accompanied by other underlying diseases(OR=4.860, P=0.010, 95%CI=1.456～16.219), postoperative indwelling catheters(OR=48.777, P<0.001, 95%CI=7.502～317.155), the operation time ≥2 h(OR=9.325, P=0.004, 95%CI=2.035～42.725) and hospital stay ≥2 weeks(OR=24.559, P=0.002, 95%CI=3.394～177.695) were independent risk factors for nosocomial infection in patients after operation. Conclusion The main pathogen of nosocomial infection in patients with ectopic pregnancy is Gram-positive bacteria. Patients with other basic diseases, indwelling catheters after surgery, long operation time and long hospital stay are all important risk factors for postoperative infections in patients.