儿童心脏外科重症监护病房医院感染临床研究

Nosocomial infection in patients with congenital heart disease after cardiac surgery in pediatric intensive care unit

目的:探讨先天性心脏病患儿术后PICU医院感染的发生情况。方法:回顾性分析行心脏手术的2 258例先天性心脏病患儿的临床资料,观察术后PICU医院感染发生率、发生部位、病原菌分布及耐药性,并进行统计分析。结果:198例患儿术后发生PICU医院感染,发生率8.77%,其中呼吸机相关性肺炎181例(8.02%)、脓毒血症10例(0.44%)、血管相关性感染7例(0.31%)。198例患儿标本中共检出病原菌242株,包括革兰阴性杆菌174株(71.9%),革兰阳性球菌30株(12.4%),真菌38株(15.7%)。复杂先天性心脏病与简单先天性心脏病患儿术后医院感染发生率比较差异有统计学意义(P<0.01)。不同住院时间患儿医院感染发生率比较差异有统计学意义(P<0.01)。随体外循环时间延长,医院感染发生率增高,差异有统计学意义(P<0.01)。常见的革兰阴性杆菌是肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌和嗜麦芽窄食单胞菌等;常见革兰阳性球菌是凝固酶阴性葡萄球菌、粪肠球菌、屎肠球菌和金黄色葡萄球菌等;真菌以白色假丝酵母菌为主。结论:先天性心脏病术后PICU医院感染发生率较高,不同感染部位病原菌分布有其自身特点。体外循环时间延长、住院时间延长可能会增加术后医院感染发生率。

Objective To investigate nosocomial infections in children with congenital heart disease after cardiac surgery in PICU.Methods The clinical data of 2 258 cases of congenital heart disease after cardiac surgery in PICU were retrospectively studied.The nosocomial infection rate,the position of infection,pathogens and the drug resistance were observed and statistically analyzed.Results Nosocomial infections occurred in 198 cases（8.77%）,in which there were 181 cases of ventilator-associated pneumonia（8.02%）,10 cases of sepsis（0.44%） and 7 cases of vascular related infection（0.31%）.The main pathogenic bacteria in nosocomial infections patients were the Gram-negative bacilli in 174 strains（71.9%）,the Gram-positive bacteria in 30 strains（12.4%）,and fungi in 38 strains（15.7%）.The nosocomial infection rate of complex congenital heart disease was significantly higher than that of simple congenital heart disease（P0.01）.There was a significant difference in infection rate between different PICU staying periods（P0.01）.The patients with longer cardiopulmonary bypass time had a higher infection rate（P0.01）.A total of 242 pathogen strains were isolated by bacterial culture.The main Gram-negative bacilli were Klebsiella pneumoniae,Pseudomonas aeruginosa,Acinetobacter baumannii,Bacillus coli and Stenotrophomonas maltophilia.The main Gram-positive bacteria were coagulase negative staphylococcus,Enterococcus faecalis and Staphylococcus aureus.The main fungus was Candida.Conclusion The rate of nosocomial infection is high in patients after cardiac surgery in PICU.The distribution of pathogens in different infection positions has its own characteristics.Long time of cardiopulmonary bypass and ICU staying may increase the nosocomial infection rate.