Analysis Of Clinical Features And Risk Factors For Postoperative Pulmonary Infection

Objectives:To investigate the clinical characteristics,pathogens distribution of postoperative pulmonary infection,identify perioperative risk factors and its influence on the prognosis of patients,so as to provide a theoretical basis for the prevention and treatment of postoperative pulmonary infection in patients undergoing surgery,and further optimize perioperative management and nosocomial infection prevention and treatment in clinical practice.Methods:A total of 17,190 surgical patients were included in this single-center retrospective study,among which,264 patients with postoperative pulmonary infection were assigned to the POP group,and 264 patients without postoperative pulmonary infection were randomly selected at a ratio of 1:1 and assigned to the non-POP group.And then the electronic health records of these patients were collected and recorded.The clinical characteristics,pathogens distribution,perioperative risk factors and prognosis of patients with postoperative pulmonary infection were investigated.The independent risk factors associated with perioperative pulmonary infection were obtained by binary Logistic regression analysis model.Results:1.A total of 264 cases were diagnosed with postoperative pulmonary infection in 17190 surgical patients,and the incidence of postoperative pulmonary infection was 1.54%.The incidence varied greatly among different surgical departments,and the infection rate of neurosurgery(17.00%)and thoracic surgery(8.67%)were significantly higher than other departments.2.Among the 153 strains of isolated pathogens,gram-positive bacteria,gram-negative bacteria and fungi accounted for 27.45%,64.05%and 8.50%,respectively.Klebsiella pneumoniae,Escherichia coli,Staphylococcus aureus and Acinetobacter baumannii were the major pathogens.There were 26 strains of multi-drug resistant bacteria,accounting for about 16.99%.3.The single-factor analysis showed 24 perioperative factors were associated with postoperative pulmonary infection(P<0.05),including male,age over 60 years old,body mass index more than 24 kg/m2,smoking history,drinking history,diabetes,hypertension,chronic obstructive pulmonary disease(COPD),malignant tumor,disturbance of consciousness,surgical grading,emergency surgery,surgery at night,operation time over 3h,intraoperative bleeding over 400ml,central venous puncture,gastric catheterization,American Society of Anesthesiologists(ASA)score,anesthesia method,intraoperative blood transfusion,intraoperative fluid infusion volume over 4000ml,endotracheal tube indwelling time more than 24h,postoperative hemoglobin lower than 100g/L,postoperative albumin lower than 35g/L,postoperative bedridden time over 3 days.4.Multivariate logistic regression analysis showed that there were six independent risk factors of postoperative pulmonary infection:age over 60 years old,COPD,emergency surgery,postoperative albumin level lower than 35g/L,endotracheal catheter indwelling time over 24 hours,postoperative bedridden time over 3 days.5.The hospital stay of POP group(24.32±14.64)was significantly longer than that of non-POP group(16.16±8.36),and the postoperative ICU occupancy rate,the second operation rate and the postoperative mortality of POP group were significantly higher than that of non-POP group.(P<0.05)Conclusions:1.The clinical feature and pathogen distribution of postoperative pulmonary infection have some significant characteristics.Strictly preventing and controlling postoperative pulmonary infection in patients undergoing neurosurgery and thoracic surgery,rational ly selecting antibiotics and actively covering gram-negative bacteria are of great significance for the prevention and treatment of nosocomial infection.2.There are many perioperative risk factors associated with postoperative pulmonary infection,among which,age over 60 years old,COPD,emergency surgery,postoperative albumin level lower than 35g/L,endotracheal catheter indwelling time over 24 hours,postoperative bedridden time over 3 days are independent risk factors of postoperative pulmonary infection.3.Postoperative pulmonary infection can lead to the poor prognosis,and proactive and adequate perioperative intervention measures to minimize the incidence of postoperative pulmonary infection can optimize the clinical outcome of patients undergoing surgery.