乳腺癌患者术后切口感染致病菌病原学特点及危险因素分析

摘要

目的：研究乳腺癌患者术后切口感染的病原菌分类及感染相关危险因素，为预防术后切口感染提供参考依据。方法选取本院2012年10月至2015年10月收治的1242例行乳腺癌手术的患者为研究对象，对发生切口感染38例患者感染部位的分泌物进行细菌学培养。统计患者术后切口感染发生率并对相关危险因素进行统计学分析。结果乳腺癌患者术后切口感染发生率为3.06%；切口感染部位检出43株病原菌，其中革兰阴性菌24株（55.8%），革兰阳性菌19株（44.2%）；耐药发生以革兰阴性菌为主。统计显示：年龄≥60岁（P ＝0.044）、临床分期Ⅲ期以上（cTNM）（P ＝0.013）、行标准根治术或扩大根治术（P ＝0.032）、营养水平差（血清白蛋白＜35 g/L）（P ＝0.012）、伴有糖尿病（P ＝0.006）、外周血白细胞计数＜4×109个/L（P ＝0.001）、细胞免疫功能低下（外周血 T 细胞总数及 CD4+T 细胞数降低）（P ＝0.012）、手术时间≥3小时（P ＝0.004）、引流时间≥15天（P ＝0.032）及术前接受辅助化疗（P ＝0.022）是乳腺癌患者术后发生切口感染的危险因素。结论乳腺癌术后切口感染原因复杂，术中加强感染控制，围术期加强营养支持、积极控制血糖，并给予患者免疫治疗及合理使用抗生素均有助于降低术后切口感染发生率。%Objective To analyze the pathogens and risk factors of surgical site infection (SSI) after breast cancer surgery, and to prevent the incidence of infection. Method 1242 patients who received breast cancer surgery in our hospital from October 2012 to October 2015 were included in this study. SSI occurred in 38 patients and the secretions were cultured for detecting pathogens. The species of pathogens and the relative risk factors were analyzed. Result The influence rate of patients with SSI was 3.06%, and there were 43 pathogens were detected from the infection site, included 24 (55.8%) Gram-negative bacteria and 19 (44.2%) Gram-positive ones. Gram-negative bacteria had the highest drug resistance rate to antibiotics. Age ≥ 60 years old (P = 0.044), clinical disease stage above Ⅲ (cTNM) (P = 0.013), radical mastectomy and extended radical mastectomy (P = 0.032), poor nutritional status (serum album lower than 35 g/L) (P = 0.012), diabetes (P =0.006), white cell count < 4×109/L (P = 0.001), deteriorated cellular immune function (downregulated total T cell and CD4 T cell in peripheral blood) (P = 0.012), operation time ≥ 3 hours (P = 0.004), drainage time ≥ 15 days (P = 0.032), preoperative chemotherapy (P = 0.022) were related to the incidence of SSI. Conclusion The reasons for SSI after breast cancer surgery are complicated. And we should strict the control measures of infection, improve perioperative nutritional support, control blood glucose, apply immunotherapy and rationally use antibiotics to reduce the incidence rate of SSI after breast cancer surgery.