神经外科颅脑手术患者医院感染危险因素分析

Risk factors of healthcareassociated infection in patients with craniocerebral operation

摘要:

目的了解神经外科颅脑手术患者医院感染危险因素，为有效预防医院感染提供依据。 方法对2010年1月—2012年12月某院神经外科收治的4 246例颅脑手术患者进行调查，分析其医院感染的危险因素。结果4 246例颅脑手术患者，术后发生医院感染393例，446例次，医院感染发病率9.26%，例次感染率10.50%；高于同期全院医院感染发病率（2.02%）和例次感染率（3.02%),差异具有统计学意义(χ2值分别为811.06、629.30，P＜0.001）。感染部位以中枢神经系统（56.50%）为主，其次是呼吸系统（27.36%）。采用非条件单因素logistic回归分析，结果显示，性别、年龄、院外感染、原发疾病、手术时间、感染前入住重症监护室（ICU）及天数、手术次数、各侵入性操作以及胃管鼻饲方面，差异有统计学意义（均P＜0.05）。将单因素有意义的指标纳入多因素logistic回归分析，结果显示，性别、老年患者、患颅脑先天性疾病、入住ICU时间＞7 d、使用抗菌药物时间＞7 d、使用中心静脉插管和泌尿道插管以及使用有创呼吸机是神经外科颅脑手术患者医院感染的危险因素。结论神经外科颅脑手术患者医院感染率较高，应加强对其医院感染的监测，同时应针对感染危险因素，采取有效的预防和控制措施，减少医院感染的发生

Abstract:

ObjectiveTo investigate risk factors for healthcareassociated infection(HAI) in patients with craniocerebral operation, and provide reference for the  prevention and control of HAI.MethodsA total of 4 246 cases of craniocerebral surgery in a neurosurgery department  from January  2010 to December 2012 were enrolled in the study,  the risk factors for HAI were analyzed.ResultsOf 4 246 cases of craniocerebral surgery, 393 patients developed 446 times of postoperative HAI,HAI incidence rate was 9.26%, case infection rate was  10.50%, which were higher than  incidence (2.02%) and case infection rate (3.02%) of HAI of all hospital during the same period,the difference was statistically significant (χ2=811.06, 629.30,respectively, P<0.001). The major infection site was  central nervous system (56.50%), followed by respiratory system (27.36%). Unconditional univariate logistic regression analysis showed that sex, age, communityacquired infection, primary disease, operative time, length of stay in intensive care unit (ICU) before infection,  the number of surgery, invasive procedures and nasogastric tube, the difference was statistically significant (all P<0.05). Multivariate logistic regression analysis showed that sex, elderly patients, congenital brain diseases, stay in ICU>7 d, antimicrobial use >7 d, central venous and urinary tract catheterization, invasive ventilator were risk factors for HAI in patients with craniocerebral operation.ConclusionThe incidence of HAI in patients with craniocerebral operation is high,effective preventive and control measures according to risk factors  should be strengthened to reduce the incidence of HAI.