The Study Of Nosocomial Infections In Perioperative Patients With Colorectal Cancer And Analysis Of Risk Factors For Surgical Site Infection

Objective:To study the status and characters of nosocomial infections (NI) in perioperative patients with colorectal cancer, the drug resistance constituent of pathogen, the risk factors for surgical site infection (SSI), so as to provide the evidence for preventing and treatment of NI and SSI.Material and Method:A retrospective survey was conducted for 3283 patients who were diagnosed as colorectal cancer and underwent radical surgical treatment from Jan 1,2010 to Dec 31,2014, including 230 cases with nosocomial infection, whose hospital infection rate, distribution, pathogen, bacterial drug resistance data were summarized. The univariate analysis was performed to screen out 22 variables with statistical significance including gender, age, previous history of abdominal surgery, diabetes, BMI, neoadjuvant therapy, preoperative anemia, preoperative hypoproteinemia, length of preoperative, postoperative and total hospitalization, ASA grade, incision size, type of incision, surgical site (rectum/colon), surgical approach (laparoscope/open), operative duration, operation frequency during one admission, length of ICU stay, tumor stage (≥ stage Ⅲ/≤ stage Ⅱ), use of glucocorticoid and preoperative application length of antibiotics (≥1/1), which were included in the multivariate logistic regression analysis to determine the risk factors for SSI. Statistical analyses were performed with the use of empowerstats software.Results:This study included 3283 admissions,230 patients acquired 283 NI episodes, with an infection rate of 7.01% and case-time infection rate of 8.62%. The length of mean and total hospitalization was 19.02 and 62,455 days respectively, with the daily infection rate of 3.68%o and daily case-time infection rate of 4.53%o, particularly the rectal group is higher than colon group in case-time rate and length of hospitalization with statistic significance. The main NI sites were respiratory system infection (35%), followed by surgical site infection, urinary system, blood system, abdominal and digestive system accounting for 24.0%,14.5%,11.3% and 5.7% respectively. Totally 528 strains of pathogen had been isolated, among which the gram-negative bacteria, gram-positive bacteria and fungi occupied 65.7%,17.0% and 17.3% respectively. The Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus, Candida albicans were detected as the main pathogens. Drug susceptibility results showed a high proportion of multi-drug resistance strains. Univariate logistic regression analysis showed previous history of abdominal surgery, BMI, preoperative hypoproteinemia, length of preoperative, postoperative and total hospitalization, ASA grade, incision size, operation duration, operation frequency, length of ICU stay and use of glucocorticoid were risk factors. The multivariate logistic regression analysis indicated previous history of abdominal surgery, BMI, preoperative hypoproteinemia, ASA grade, incision size, use of glucocorticoid were independent risk factors of SSI in perioperative patients with colorectal cancer.Conclusion:(1) The NI rate in perioperative patients with colorectal cancer were high and rectal group had higher case-time rate and longer duration of hospitalization. (2)The postoperative pneumonia, surgical site, hematological system and catheter related urinary tract infections were most frequently occurred in postoperative colorectal cancer patients. (3) For different infection distribution, give timely and appropriate empirical use of antimicrobial agents, especially targeting Escherichia coli, Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus, Candida albicans, before having specific pathogen and drug susceptibility results. (4) The high risk group of SSI in perioperative patients with colorectal cancer featured as previous history of abdominal surgery, obesity, preoperative hypoproteinemia, high ASA grade, bigger incision size, use of glucocorticoid was urgent to strengthen the perioperative guideline to decrease the incidence of SSI for Medical staff.