胰十二指肠切除术后手术部位感染的病原体分布及危险因素分析-东南大学学报医学版

胰十二指肠切除术后手术部位感染的病原体分布及危险因素分析

单位：1. 连云港市第一人民医院感染管理科, 江苏连云港 222000;
2. 如东县人民医院感染管理科, 江苏南通 226400;
3. 南京明基医院医院感染管理办公室, 江苏南京 210019;
4. 南京医科大学第一附属医院感染管理处, 江苏南京 210029

关键词：胰十二指肠切除术手术部位感染病原体危险因素

分类号：R657.5;R373

出版年·卷·期（页码）：2025·44·第五期（764-772）

摘要：

目的:探讨胰十二指肠切除术后患者发生手术切口部位感染的病原体分布及相关危险因素。方法:回顾性分析2022年1月至2023年6月于南京医科大学第一附属医院行胰十二指肠切除术的683例患者的临床资料,统计患者手术部位感染情况,分析患者年龄、性别、吸烟史、糖尿病等情况,分析胰十二指肠切除术患者术后手术部位感染的病原体分布情况及手术部位感染的相关危险因素。结果:共纳入683例患者,男427例(62.51%),女256例(37.48%),平均年龄(61.91±10.91)岁。胰十二指肠切除术患者手术部位感染率为12.30%(84/683),主要以器官/腔隙感染为主。共培养分离病原菌128株,其中革兰氏阴性菌66株,占51.56%;革兰氏阳性菌48株,占37.50%;真菌14株,占10.94%。以肺炎克雷伯菌、屎肠球菌为主。重点监测多重耐药菌中耐甲氧西林金黄色葡萄球菌(MRSA)检出率最高,达70%(7/10)。多因素Logistics回归分析显示,患者性别为女性(OR=0.59,95%CI 0.38~0.93)、手术医生为"其他"类型(OR=0.29,95%CI 0.09~0.94)的患者,其术后发生手术部位感染的风险较低,而BMI(OR=1.17,95%CI 1.10~1.23)、术中置入胆管或胰管支架(OR=2.34, 95%CI 1.57~3.49)为发生手术部位感染的独立危险因素。结论:胰十二指肠切除术后手术部位感染风险高,病原菌以革兰氏阴性菌为主,对多种抗菌药物有较强的耐药性;胰十二指肠切除术复杂,影响手术部位感染的因素较多,应根据患者自身情况分析潜在的风险因素,积极采取措施,预防术后发生手术部位感染。

Objective: To investigate the distribution of pathogens and associated risk factors for surgical site infection(SSI) following pancreaticoduodenectomy(PD). Methods: A retrospective analysis was conducted on the clinical data of 683 patients who underwent PD at the First Affiliated Hospital of Nanjing Medical University between January 2022 and June 2023. SSI incidence was recorded, and variables such as age, sex, smoking history, and diabetes status were analyzed. The distribution of pathogens causing SSI and related risk factors were summarized. Results: A total of 683 patients were included, comprising 427 males(62.51%) and 256 females(37.48%), with a mean age of(61.91±10.91) years. The overall SSI rate after PD was 12.30%(84/683), with organ/space infections being the predominant type. A total of 128 pathogens were isolated, including 66 Gram-negative bacteria(51.56%), 48 Gram-positive bacteria(37.50%), and 14 fungi(10.94%). Klebsiella pneumoniae and Enterococcus faecium were the most common pathogens. Among the monitored multidrug-resistant organisms(MDROs),methicillin-resistant Staphylococcus aureus(MRSA) had the highest detection rate at 70%(7/10). Multivariate Logistic regression analysis showed that female(OR=0.59, 95% CI 0.38-0.93) and surgeries performed by "other" types of surgeons(OR=0.29, 95% CI 0.09-0.94) were associated with a lower risk of SSI, whereas higher BMI(OR=1.17, 95% CI 1.10-1.23) and intraoperative placement of biliary or pancreatic duct stents(OR=2.34, 95% CI 1.57-3.49) were independent risk factors. Conclusion: The risk of SSI following PD is relatively high, with Gram-negative bacteria as the predominant pathogens, many of which exhibit multidrug resistance. Given the complexity of PD, various factors contribute to postoperative SSI. Therefore, individualized risk assessment and proactive preventive strategies are essential to reduce SSI incidence.

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