小儿心脏术后中心静脉导管培养的菌群分布与相关因素分析

目的研究小儿先天性心脏病外科手术后中心静脉导管培养的菌群分布情况以及导管培养阳性的相关因素，为临床科学管理中心静脉导管，降低导管相关感染的发生提供方法。方法2010年1月至2011年12月连续两年对334例0～14岁先天性心脏病患儿留置的中心静脉导管进行尖端细菌培养加药敏。结果334例中心静脉导管共培养出43株病原菌，培养的阳性率为12．57％。最常见的病原菌是鲍曼不动杆菌，革兰氏阴性杆菌药敏结果显示氨苄西林耐药率最高；革兰氏阳性球茵药敏结果显示红霉素耐药率最高。导管留置时间越长，术中体外循环转流时间越长，ICU停留时间越长，细菌培养的阳性率越高；阳性率与手术类型、导管置入位置无关。结论中心静脉导管作为小儿心脏手术后留置的生命通道，也是临床院内感染的主要来源。加强无菌操作观念，尽量在3d内拔除中心静脉导管，合理使用抗生素，可降低导管相关感染。

Objective The aim of this paper was to study the bacterial distribution and factors for positive culture after pediatric cardiac surgery,so as to provide the basis for clinical management of central venous catheters (CVC) and reduce catheter-related infections.Methods From Jan.2010 to Dec.2011,334 consecutive patients aged 0-14 years old after cardiac surgery were chosen.CVC tips were sent for bacterial culture and antibiotic sensitivity.Results Out of the 334 cases,43 were showed to be culture positive (12.57％).The most common pathogens was Acinetobacter baumannii.Gramnegative bacilli susceptibility results showed the highest resistance rates to ampicillin; Gram-positive cocci susceptibility results showed that the highest resistance rate to erythromycin.CVC indwelling time,cardiopulmonary bypass time and ICU stay time correlated positively with bacterial culturepositive rate.The type of surgery and catheter position did not affect the positive rate.Conclusions CVC is a major source of nosocomial infections.Thus,the concept of aseptic technique,removal of CVC within three days and rational use of antibiotics are important factors to reduce catheter-related infections.