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中华肩肘外科电子杂志

中华肩肘外科电子杂志 ›› 2020, Vol. 08 ›› Issue (01) : 62 -67. doi: 10.3877/cma.j.issn.2095-5790.2020.01.010

所属专题： 文献；

论著

创伤骨科住院患者手术部位感染的流行病学特点及相关危险因素分析：单中心回顾性研究
王艳华1, 张晓萌1, 薛峰1, 陈建海1, 张培训1, 熊健1, 徐海林1, 党育1, 杨明1, 付中国1, 张殿英1,†()   
  1. 1. 100044　北京大学人民医院创伤骨科
  • 收稿日期:2020-01-02 出版日期:2020-02-05
  • 通信作者: 张殿英
  • 基金资助:
    国家自然科学基金主任基金(31640045); 国家自然科学基金面上项目(31671246); 国家重点研发计划(2016YFC1101604); 教育部创新团队项目(IRT_16R01); 创伤救治与神经再生教育部重点实验室(BMU2019XY007-01); 北京大学临床科学家计划专项(BMU2019LCKXJ005)

Epidemiological characteristics of surgical site infection and analysis of related risk factors in hospitalized patients of traumatic orthopedics: a single-center retrospective study

Yanhua Wang1, Xiaomeng Zhang1, Feng Xue1, Jianhai Chen1, Peixun Zhang1, Jian Xiong1, Hailin Xu1, Yu Dang1, Ming Yang1, Zhongguo Fu1, Dianying Zhang1,†()   

  1. 1. Department of Trauma and Orthopeadics, Peking University People's Hospital, Peking University, Traffic Medicine Center, Beijing 100044, China
  • Received:2020-01-02 Published:2020-02-05
  • Corresponding author: Dianying Zhang
  • About author:
    Corresponding author: Zhang Dianying, Email:.
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王艳华, 张晓萌, 薛峰, 陈建海, 张培训, 熊健, 徐海林, 党育, 杨明, 付中国, 张殿英. 创伤骨科住院患者手术部位感染的流行病学特点及相关危险因素分析：单中心回顾性研究[J]. 中华肩肘外科电子杂志, 2020, 08(01): 62-67.

Yanhua Wang, Xiaomeng Zhang, Feng Xue, Jianhai Chen, Peixun Zhang, Jian Xiong, Hailin Xu, Yu Dang, Ming Yang, Zhongguo Fu, Dianying Zhang. Epidemiological characteristics of surgical site infection and analysis of related risk factors in hospitalized patients of traumatic orthopedics: a single-center retrospective study[J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2020, 08(01): 62-67.

目的

调查本院创伤骨科手术部位感染（surgical site infection，SSI）患者的发病情况，并分析感染原因，为预防和控制SSI提供依据。

方法

选取本院自2015年1月至2019年12月期间创伤骨科所有住院手术患者为研究对象，共计10 645例患者，依据卫生部2001年颁布的《医院感染诊断标准（试行）》进行医院感染病例诊断，并根据临床科室上报的医院感染资料信息进行病历筛选和回顾性分析。

结果

10 645例创伤骨科手术患者中，31例患者发生SSI，感染发生率为0.29%。2016年至2019年感染发生率呈逐年下降趋势。感染的主要病原菌为G（+）球菌，占87.50%。感染类型主要是器官（或腔隙）感染，占61.29%。患者年龄、体重指数、手术时间、手术方式、手术部位与骨科手术患者SSI的发生有相关性（P<0.05）。

结论

创伤骨科手术患者SSI是临床上不可回避的问题，应重视相关危险因素，积极采取有针对性的预防控制措施改善可变因素，以有效降低骨科手术患者SSI的发生。

关键词: 创伤骨科, 手术部位感染, 流行病学特点, 危险因素, 回顾性分析
Background

Surgical site infection (SSI) refers to nosocomial infections that occur in surgical incisions, deep organs or cavities after surgical operations, and is still one of the severe complications after modern orthopedic surgery. Despite good medical measures and surgical management, SSIs of orthopedic patients interfere with the functional recovery of motor system, prolong the length of hospital stay, increase the patient's financial burden, and seriously affect the quality of medical care and the patient safety. The widespread application of implants in orthopedic surgeries has increased the risk of invasive factors, making orthopedic patients at high risk of nosocomial infection.ObjectiveTo investigate the incidence of patients with SSIs in the department of traumatic orthopedics and traumatology in our hospital, and analyze the causes of the infection to provide evidence for the prevention and control of SSI.

Methods

From January 2015 to December 2019, a total of 10 645 patients in the department of orthopedics and traumatology in our hospital were selected as the research subjects. Nosocomial infection cases were diagnosed according to the Nosocomial infection diagnostic criteria (trial) issued by the Ministry of Health in 2001. and the medical records were screened and retrospectively analyzed according to the information of nosocomial infection reported by our department.

Results

Among 10 645 patients with orthopedic surgeries, 31 patients were diagnosed as SSIs, and the SSI rate was 0.29%. From 2016 to 2019, the incidence of SSI showed a downward trend year by year. The main pathogenic infection was Gram-positive cocci, accounting for 87.50%. The major type of SSI was organ (or cavity) infection, accounting for 61.29%. Patient age, body mass index (BMI) , operation time, operation method and operation site were correlated with the occurrence of SSI in orthopedic patients (P<0.05) .

Conclusions

SSI is an unavoidable problem in patients with orthopedic surgery. We should pay attention to the relevant risk factors and actively take targeted preventive and control measures to improve modifiable factors in order to effectively reduce the incidence of SSI in orthopedic patients.

Key words: Traumatic orthopedics, Surgical site infection, Epidemiological characteristics, Risk factors, Retrospective analysis
表1 2015年至2019年骨科患者SSI发生率
年份 调查例数 SSI例数 SSI发生率（%）
2015 1 948 4 0.21
2016 1 853 11 0.59
2017 2 135 7 0.33
2018 2 295 6 0.26
2019 2 414 3 0.12
表2 2015年至2019年创伤骨科SSI患者病原菌分布
病原菌 菌株数 构成比（%）
MRSA 8 25.00
表皮葡萄球菌 7 21.88
MSSA 5 15.63
铜绿假单胞菌 2 6.25
溶血性葡萄球菌 2 6.25
粪肠球菌 3 9.38
鲍曼不动杆菌 1 3.13
山羊葡萄球菌 1 3.13
大肠埃希菌 1 3.13
蜡样芽胞杆菌 1 3.13
阴沟肠杆菌 1 3.13
合计 32 100.00
表3 2015年至2019年骨科患者SSI类型
感染分类 感染例数 感染率（%）
浅表手术切口感染 5 16.13
深部手术切口感染 7 22.58
器官（或腔隙）感染 19 61.29
表4 骨科手术患者SSI与相关因素的关系
相关因素 调查例数 SSI例数 SSI发病率（%） x2值 P值
性别 男 4 856 15 0.31 0.096 >0.05
女 5 789 16 0.28
年龄（岁） <18 14 2 14.29 46.197 <0.01
18~60 10 399 21 0.20
≥60 232 8 3.45
BMI 偏瘦（<18.5） 579 1 0.17 15.256 <0.01
正常（18.5~23.9） 4 516 10 0.22
偏胖（24~26.9） 3 082 7 0.23
肥胖（27~29.9） 1 613 5 0.31
重度肥胖（≥30） 862 8 0.93
手术时间（h） <2 8 190 15 0.18 14.283 <0.01
≥2 6 399 16 0.65
ASA评分 I级 4 230 15 0.35 0.971 >0.05
II~V级 6 415 16 0.25
手术方式 镜下手术 2 280 5 0.22 5.755 <0.05
开放手术 8 365 26 0.31
麻醉方法 全麻 2 824 8 0.28 0.008 >0.05
非全麻 7 821 23 0.29
手术部位 颈、胸、肩部及上肢 4 272 7 0.16 3.986 <0.05
腰骶、骨盆、髋部及下肢 6 373 24 0.38
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