Analysis of factors influencing postoperative infection in patients with gynecological malignant tumors

doi:10.3877/cma.j.issn.1673-5250.2025.06.012

Objective

To explore the influencing factors of postoperative infection in patients with gynecological malignant tumors.

Methods

A total of 234 patients with gynecological malignancies who underwent surgical treatment at the Department of Gynecology, Chongqing General Hospital, Chongqing University from April 2020 to March 2023 were selected as the study subjects. Among them, 80 cases were cervical cancer, 107 cases were ovarian cancer, and 47 cases were endometrial cancer. Patients were divided into infection group (n=55) and non-infection group (n=179) based on whether they developed postoperative infection. A retrospective analysis was conducted to collect general clinical data and preoperative, surgical, and postoperative data from both groups, and comparative analyses were performed using independent-samples t test and chi-square test. Multivariate unconditional logistic regression analysis was used to analyze the independent influencing factors of postoperative infection in gynecological malignant tumor patients. There were no statistically significant differences in age, body mass index (BMI), or other general clinical data between two groups (P>0.05). The procedures followed in this study were approved by the Medical Ethics Committee of Chongqing General Hospital, Chongqing University (Approval No. KYS2022-012-01).

Results

①Among 234 patients with gynecological malignancies, 55 cases (23.5%) developed postoperative infections. Of the 55 infected patients, 60 strains of pathogens were cultured, with Escherichia coli having the highest incidence (32/55, 58.2%), followed by Pseudomonas aeruginosa (5/55, 9.1%), Enterobacter cloacae subsp. cloacae (4/55, 7.3%), and Klebsiella pneumoniae (4/55, 7.3%); 8 cases (14.5%) had dual bacterial infections. ②Univariate analysis revealed that there were statistically significant differences between two groups in 13 factors, including tumor type, American Society of Anesthesiologists (ASA) classification, operation duration, type of vaginal stump suture, use of drainage tube, drainage tube placement location, duration of indwelling drainage tube, number of urinary catheter insertions, duration of indwelling urinary catheter, ≥1 central venous catheterization, duration of central venous catheterization, types of postoperative use of antibiotics, and duration of antibiotic use (P<0.05). ③Multivariate unconditional logistic regression analysis showed that ASA classification Ⅲ+ Ⅳ and conventional suture for vaginal stump closure were independent risk factors for postoperative infection in patients with gynecological tumors (OR=3.266, 3.632, 95%CI: 1.361-7.645, 1.454-9.072, P=0.008, 0.006). Compared to postoperative cephalosporin antibiotics alone, postoperative use of non-cephalosporin antibiotics was an independent protective factor against postoperative infection in patients with gynecological malignancies (OR=0.298, 95%CI: 0.127-0.702, P=0.006). Compared to postoperative antibiotic use for 1-3 days, postoperative antibiotic use for 4-7 days and ≥8 days were also independent protective factors against postoperative infection in patients with gynecological malignancies (OR=0.103, 0.073, 95%CI: 0.031-0.340, 0.019-0.277, both P<0.001).

Conclusions

ASA classification, vaginal suture type, type of postoperative antibiotics used, and duration of postoperative antibiotic use are all independent influencing factors for postoperative infection in patients with gynecological malignancies. Postoperative nutritional intervention, intraoperative antimicrobial suture utilization, proper postoperative use of antibiotics and standardized postoperative antibiotic protocols may effectively reduce the risk of postoperative infection in patients with gynecological malignancies.

Key words: Genital neoplasms, female, Postoperative infections, Root cause analysis, Female

表1 感染组与非感染组妇科恶性肿瘤患者一般临床资料和术前相关资料比较

组别	例数	肿瘤类型[例数(%)]			发病年龄(岁，±s)	BMI(kg/m²，±s)	血压增高[例数(%)]	血糖增高[例数(%)]
组别	例数	宫颈癌	卵巢癌	子宫内膜癌	发病年龄(岁，±s)	BMI(kg/m²，±s)	血压增高[例数(%)]	血糖增高[例数(%)]
感染组	55	32(58.2)	13(23.6)	10(18.2)	54.4±10.9	23.5±3.7	16(29.1)	7(12.7)
非感染组	179	63(35.2)	77(43.0)	39(21.8)	55.3±10.9	23.0±3.4	45(25.1)	35(19.6)
统计量		χ²＝9.84			t＝0.56	t＝－0.95	χ²＝0.34	χ²＝1.33
P值		0.007			0.579	0.344	0.559	0.249
组别	例数	术前营养状况异常[例数(%)]	白带检查结果异常[例数(%)]	合并阴道炎[例数(%)]	规范治疗阴道炎[例数(%)]	有内科合并症[例数(%)]	术前贫血[例数(%)]	术前输血[例数(%)]
感染组	55	2(3.6)	12(21.8)	13(23.6)	13(23.6)	21(38.2)	13(23.6)	2(3.6)
非感染组	179	6(3.4)	36(20.1)	35(19.6)	35(19.6)	81(45.3)	58(32.4)	4(2.2)
统计量		χ²＝0.10^a	χ²＝0.08	χ²＝0.43	χ²＝0.43	χ²＝0.86	χ²＝1.53	χ²＝0.01^a
P值		0.752	0.784	0.512	0.512	0.355	0.216	0.930
组别	例数	术前白蛋白(g/L，±s)	术前前白蛋白[mg/L，M(Q₁，Q₃)]	术前白细胞计数[×10⁹/L，M(Q₁，Q₃)]	入院前有感染[例数(%)]	术前进行抗感染治疗[例数(%)]	有盆腹腔手术史[例数(%)]
感染组	55	41.9±7.6	224.9(201.5，254.8)	5.2(4.3，6.5)	0(0)	0(0)	25(45.5)
非感染组	179	41.3±5.4	218.7(191.0，252.4)	5.6(4.5，7.2)	2(1.1)	1(0.6)	75(41.9)
统计量		t＝－1.59	Z＝－0.88	Z＝－1.64	—^b	—^b	χ²＝0.22
P值		0.113	0.376	0.102	0.530	>0.999	0.641

表1 感染组与非感染组妇科恶性肿瘤患者一般临床资料和术前相关资料比较

组别	例数	肿瘤类型[例数(%)]			发病年龄(岁，±s)	BMI(kg/m²，±s)	血压增高[例数(%)]	血糖增高[例数(%)]
组别	例数	宫颈癌	卵巢癌	子宫内膜癌	发病年龄(岁，±s)	BMI(kg/m²，±s)	血压增高[例数(%)]	血糖增高[例数(%)]
感染组	55	32(58.2)	13(23.6)	10(18.2)	54.4±10.9	23.5±3.7	16(29.1)	7(12.7)
非感染组	179	63(35.2)	77(43.0)	39(21.8)	55.3±10.9	23.0±3.4	45(25.1)	35(19.6)
统计量		χ²＝9.84			t＝0.56	t＝－0.95	χ²＝0.34	χ²＝1.33
P值		0.007			0.579	0.344	0.559	0.249
组别	例数	术前营养状况异常[例数(%)]	白带检查结果异常[例数(%)]	合并阴道炎[例数(%)]	规范治疗阴道炎[例数(%)]	有内科合并症[例数(%)]	术前贫血[例数(%)]	术前输血[例数(%)]
感染组	55	2(3.6)	12(21.8)	13(23.6)	13(23.6)	21(38.2)	13(23.6)	2(3.6)
非感染组	179	6(3.4)	36(20.1)	35(19.6)	35(19.6)	81(45.3)	58(32.4)	4(2.2)
统计量		χ²＝0.10^a	χ²＝0.08	χ²＝0.43	χ²＝0.43	χ²＝0.86	χ²＝1.53	χ²＝0.01^a
P值		0.752	0.784	0.512	0.512	0.355	0.216	0.930
组别	例数	术前白蛋白(g/L，±s)	术前前白蛋白[mg/L，M(Q₁，Q₃)]	术前白细胞计数[×10⁹/L，M(Q₁，Q₃)]	入院前有感染[例数(%)]	术前进行抗感染治疗[例数(%)]	有盆腹腔手术史[例数(%)]
感染组	55	41.9±7.6	224.9(201.5，254.8)	5.2(4.3，6.5)	0(0)	0(0)	25(45.5)
非感染组	179	41.3±5.4	218.7(191.0，252.4)	5.6(4.5，7.2)	2(1.1)	1(0.6)	75(41.9)
统计量		t＝－1.59	Z＝－0.88	Z＝－1.64	—^b	—^b	χ²＝0.22
P值		0.113	0.376	0.102	0.530	>0.999	0.641

表2 感染组与非感染组妇科恶性肿瘤患者手术季节及手术相关资料比较[例数(%)]

组别	例数	手术季节				ASA分级		手术方式		术中使用抗菌药物
组别	例数	春季	夏季	秋季	冬节	Ⅰ＋Ⅱ级	Ⅲ＋Ⅳ级	开腹	腹腔镜	术中使用抗菌药物
感染组	55	17(30.9)	16(29.1)	12(21.8)	10(5.6)	40(72.7)	15(27.3)	45(81.8)	10(18.2)	10(18.2)
非感染组	179	42(23.5)	59(33.0)	39(21.8)	39(21.8)	90(50.3)	89(49.7)	157(87.7)	22(12.3)	41(22.9)
χ²值		1.38				8.59		1.24		0.55
P值		0.710				0.003		0.266		0.458
组别	例数	手术时长			麻醉方式		术中出血量
组别	例数	<1 h	≥1~3 h	≥3 h	全身麻醉	其他	<200 mL	200~500 mL	>500 mL
感染组	55	1(1.8)	5(9.1)	49(89.1)	55(100.0)	0(0)	32(58.2)	14(25.4)	9(16.4)
非感染组	179	19(10.6)	28(15.6)	132(73.7)	175(97.8)	4(2.2)	124(69.3)	39(21.8)	16(8.9)
χ²值		6.37			—^a		3.20
P值		0.041			0.340		0.202
组别	例数	术中输血治疗	手术时手术室内最多人数		阴道断端缝线种类		引流管留置位置
组别	例数	术中输血治疗	<8人	≥8人	抗菌倒刺缝线	普通微荞线	无	盆腔	上腹部＋盆腔
感染组	55	4(7.3)	54(98.2)	1(1.8)	45(81.8)	10(18.2)	8(14.6)	46(83.6)	1(1.8)
非感染组	179	10(5.6)	165(92.2)	14(7.8)	109(60.9)	70(39.1)	57(31.8)	120(67.0)	2(1.2)
χ²值		0.02^b	1.63^b		8.19		—^a
P值		0.892	0.202		0.004		0.042
组别	例数	使用引流管	引流管引出位置^c			引流管留置时间
组别	例数	使用引流管	经腹部	经阴道	经腹部＋阴道	未插管	1~3 d	4~7 d	≥8 d
感染组	55	47(85.5)	15(31.9)	31(66.0)	1(2.1)	8(14.5)	23(41.8)	19(34.6)	5(9.1)
非感染组	179	122(67.0)	43(35.2)	77(63.1)	2(1.6)	57(31.8)	39(21.9)	62(34.6)	21(11.7)
χ²值		6.28	<0.01			11.17
P值		0.012	0.953			0.011

表2 感染组与非感染组妇科恶性肿瘤患者手术季节及手术相关资料比较[例数(%)]

组别	例数	手术季节				ASA分级		手术方式		术中使用抗菌药物
组别	例数	春季	夏季	秋季	冬节	Ⅰ＋Ⅱ级	Ⅲ＋Ⅳ级	开腹	腹腔镜	术中使用抗菌药物
感染组	55	17(30.9)	16(29.1)	12(21.8)	10(5.6)	40(72.7)	15(27.3)	45(81.8)	10(18.2)	10(18.2)
非感染组	179	42(23.5)	59(33.0)	39(21.8)	39(21.8)	90(50.3)	89(49.7)	157(87.7)	22(12.3)	41(22.9)
χ²值		1.38				8.59		1.24		0.55
P值		0.710				0.003		0.266		0.458
组别	例数	手术时长			麻醉方式		术中出血量
组别	例数	<1 h	≥1~3 h	≥3 h	全身麻醉	其他	<200 mL	200~500 mL	>500 mL
感染组	55	1(1.8)	5(9.1)	49(89.1)	55(100.0)	0(0)	32(58.2)	14(25.4)	9(16.4)
非感染组	179	19(10.6)	28(15.6)	132(73.7)	175(97.8)	4(2.2)	124(69.3)	39(21.8)	16(8.9)
χ²值		6.37			—^a		3.20
P值		0.041			0.340		0.202
组别	例数	术中输血治疗	手术时手术室内最多人数		阴道断端缝线种类		引流管留置位置
组别	例数	术中输血治疗	<8人	≥8人	抗菌倒刺缝线	普通微荞线	无	盆腔	上腹部＋盆腔
感染组	55	4(7.3)	54(98.2)	1(1.8)	45(81.8)	10(18.2)	8(14.6)	46(83.6)	1(1.8)
非感染组	179	10(5.6)	165(92.2)	14(7.8)	109(60.9)	70(39.1)	57(31.8)	120(67.0)	2(1.2)
χ²值		0.02^b	1.63^b		8.19		—^a
P值		0.892	0.202		0.004		0.042
组别	例数	使用引流管	引流管引出位置^c			引流管留置时间
组别	例数	使用引流管	经腹部	经阴道	经腹部＋阴道	未插管	1~3 d	4~7 d	≥8 d
感染组	55	47(85.5)	15(31.9)	31(66.0)	1(2.1)	8(14.5)	23(41.8)	19(34.6)	5(9.1)
非感染组	179	122(67.0)	43(35.2)	77(63.1)	2(1.6)	57(31.8)	39(21.9)	62(34.6)	21(11.7)
χ²值		6.28	<0.01			11.17
P值		0.012	0.953			0.011

表3 感染组与非感染组妇科恶性肿瘤患者术后相关资料比较[例数(%)]

组别	例数	使用抗菌药物类型			双抗菌药物联用[例数(%)]	初次手术后30 d内手术总次数		术后转ICU[例数(%)]
组别	例数	单用头孢类抗菌药物	头孢类抗菌药＋奥硝唑物	非头孢类抗菌药物	双抗菌药物联用[例数(%)]	0次	≥1次	术后转ICU[例数(%)]
感染组	55	3(5.5)	20(36.4)	32(58.2)	51(92.7)	44(0.8)	11(0.2)	2(3.6)
非感染组	179	28(15.6)	107(59.8)	44(24.6)	148(82.7)	148(82.7)	31(17.3)	2(1.1)
χ²值		22.17			2.60	0.20		—^a
P值		<0.001			0.107	0.650		0.506
组别	例数	尿管插管次数		尿管留置时间				中心静脉插管≥1次
组别	例数	≤1次	>1次	≤1 d	2~3 d	4~7 d	≥8 d	中心静脉插管≥1次
感染组	55	34(61.8)	21(38.2)	10(18.2)	9(16.4)	2(3.6)	34(61.8)	39(70.9)
非感染组	179	144(80.4)	35(19.6)	75(41.9)	44(24.6)	22(12.3)	38(21.2)	99(55.3)
χ²值		8.02		33.37				4.23
P值		0.005		<0.001				0.040
组别	例数	中心静脉插管时间			抗菌药物使用时间
组别	例数	未插管	≤7 d	>7 d	1~3 d	4~7 d	≥8 d
感染组	55	16(29.1)	10(18.2)	29(52.7)	13(23.6)	6(10.9)	36(65.5)
非感染组	179	80(44.6)	57(31.8)	42(23.5)	83(46.4)	73(40.8)	23(12.8)
χ²值		17.11			62.60
P值		<0.001			<0.001

表3 感染组与非感染组妇科恶性肿瘤患者术后相关资料比较[例数(%)]

组别	例数	使用抗菌药物类型			双抗菌药物联用[例数(%)]	初次手术后30 d内手术总次数		术后转ICU[例数(%)]
组别	例数	单用头孢类抗菌药物	头孢类抗菌药＋奥硝唑物	非头孢类抗菌药物	双抗菌药物联用[例数(%)]	0次	≥1次	术后转ICU[例数(%)]
感染组	55	3(5.5)	20(36.4)	32(58.2)	51(92.7)	44(0.8)	11(0.2)	2(3.6)
非感染组	179	28(15.6)	107(59.8)	44(24.6)	148(82.7)	148(82.7)	31(17.3)	2(1.1)
χ²值		22.17			2.60	0.20		—^a
P值		<0.001			0.107	0.650		0.506
组别	例数	尿管插管次数		尿管留置时间				中心静脉插管≥1次
组别	例数	≤1次	>1次	≤1 d	2~3 d	4~7 d	≥8 d	中心静脉插管≥1次
感染组	55	34(61.8)	21(38.2)	10(18.2)	9(16.4)	2(3.6)	34(61.8)	39(70.9)
非感染组	179	144(80.4)	35(19.6)	75(41.9)	44(24.6)	22(12.3)	38(21.2)	99(55.3)
χ²值		8.02		33.37				4.23
P值		0.005		<0.001				0.040
组别	例数	中心静脉插管时间			抗菌药物使用时间
组别	例数	未插管	≤7 d	>7 d	1~3 d	4~7 d	≥8 d
感染组	55	16(29.1)	10(18.2)	29(52.7)	13(23.6)	6(10.9)	36(65.5)
非感染组	179	80(44.6)	57(31.8)	42(23.5)	83(46.4)	73(40.8)	23(12.8)
χ²值		17.11			62.60
P值		<0.001			<0.001

表4 妇科恶性肿瘤患者术后感染影响因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
ASA分级为Ⅲ＋Ⅳ级(vs Ⅰ＋Ⅱ级)	1.171	0.440	7.081	0.008	3.226	1.361~7.645
阴道断端缝线为普通微荞线(vs抗菌倒刺缝线)	1.290	0.467	7.629	0.006	3.632	1.454~9.072
术后使用抗菌药物类型(vs单用头孢类抗菌药物)
头孢类抗菌药物＋奥硝唑	－0.585	0.760	0.593	0.441	0.557	0.126~2.470
非头孢类抗菌药物	－1.209	0.437	7.668	0.006	0.298	0.127~0.702
术后抗菌药物使用时间(vs 1~3 d)
4~7 d	－2.271	0.460	24.344	<0.001	0.103	0.042~0.254
≥8 d	－2.998	0.588	25.973	<0.001	0.050	0.016~0.158
常数项	－0.509	0.490	1.080	0.299	0.601	—

表4 妇科恶性肿瘤患者术后感染影响因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
ASA分级为Ⅲ＋Ⅳ级(vs Ⅰ＋Ⅱ级)	1.171	0.440	7.081	0.008	3.226	1.361~7.645
阴道断端缝线为普通微荞线(vs抗菌倒刺缝线)	1.290	0.467	7.629	0.006	3.632	1.454~9.072
术后使用抗菌药物类型(vs单用头孢类抗菌药物)
头孢类抗菌药物＋奥硝唑	－0.585	0.760	0.593	0.441	0.557	0.126~2.470
非头孢类抗菌药物	－1.209	0.437	7.668	0.006	0.298	0.127~0.702
术后抗菌药物使用时间(vs 1~3 d)
4~7 d	－2.271	0.460	24.344	<0.001	0.103	0.042~0.254
≥8 d	－2.998	0.588	25.973	<0.001	0.050	0.016~0.158
常数项	－0.509	0.490	1.080	0.299	0.601	—

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