冠状动脉移植术后并发脑卒中患者主动脉内球囊反搏辅助治疗的医院感染分析

Analysis of nosocomial infection in stroke patients treated with intra-aortic balloon pump after coronary artery bypass grafting

目的分析冠状动脉移植术后并发脑卒中患者主动脉内球囊反搏(IABP)辅助治疗的医院感染病原菌分布、耐药情况及其危险因素。方法回顾性收集、分析北京安贞医院2009年1月～2012年12月冠状动脉移植术后并发脑卒中患者IABP辅助治疗的医院感染临床资料。结果 128例患者,平均年龄(68.8±4.6)岁,其中发生医院感染56例,感染率43.8%。共分离出阳性菌145株,其中革兰氏阴性菌89株(61.4%),以鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和阴沟肠杆菌居多,并显示多药耐药;革兰氏阳性菌36株(24.8%),包括金黄色葡萄球菌、表皮葡萄球菌和溶血葡萄球菌等,对万古霉素较敏感;真菌20株(13.8%),主要有白色假丝酵母菌和光滑球拟假丝酵母菌等,对氟康唑、5-氟胞嘧啶等敏感性较高。医院感染组患者死亡30例(53.6%),非医院感染组死亡16例(22.2%),两组患者病死率差异有统计学意义(P<0.01)。多因素logistic回归分析医院感染与二次气管插管及ICU滞留时间有关。结论冠状动脉移植术后并发脑卒中患者IABP辅助治疗的医院感染发病率高,是其死亡危险因素之一,并且二次气管插管及ICU滞留时间是其独立危险因素,应严格无菌操作,合理使用抗菌药物,以降低病死率。

【Objective】 To analyze the risk factors and the bacterial distribution of Nosocomial infection in stroke patients treated with intra-aortic balloon pump（IABP） after coronary artery bypass grafting（CABG） and their drug.【Methods】 The clinical data of stroke patients who underwent CABG with application of IABP from January 2009 to December 2012 were retrospectively collected and analyzed.【Results】 The average age of 128 cases was（68.8 ± 4.6） years.The incidence of Nosocomial infection was 43.8% in all 128 cases.There were 145 strains of pathogenic bacilli isolated,which included Gram-negative bacteria（61.4%）,Gram-positive bacteria（24.8%）,and fungi（13.8%）.The Gram-negative bacteria such as baumanii,pseudomonas aeruginosa and enterobacter cloacae,showed multi-drug resistance.The Gram-positive bacteria including staphylococcus aureus,staphylococcus epidermidis and staphylococcushaemolyticus were more sensitive to Vancomycin.The fungi including candida albicans and torulopsis candida were sensitive to fluconazole and 5-fluorocytosine.The hospital mortality was much higher among patients with Nosocomial infection than that without Nosocomial infection（53.6% vs 22.2%,P ＆lt;0.01）.The nosocomial infection was related with re-intubation and length of ICU stay according to the logistic regression analysis.【Conclusions】 The incidence of Nosocomial infection in stroke patients with IABP after CABG is high,and is one of the risk factors of hospital mortality.And the independent risk factors of postoperative nosocomial infection are re-intubation and length of ICU stay.So it is important to take the operations under sterility strictly and use the antibiotics rationally to reduce the infection rate and mortality.