肝移植术后患者医院感染的流行病学特征

Epidemiological analysis of nosocomial infections after liver transplantation

目的分析肝移植患者术后医院感染的流行病学特征,为医院感染防控措施的制定提供依据。方法回顾性调查2015年1月-2017年12月广州市某三甲医院391例肝移植住院患者的临床资料,采用描述性研究的方法,对患者肝移植术后发生医院感染的情况进行统计分析。结果 391例肝移植患者中,48例发生术后医院感染,感染率为12.28%,平均感染例次1.42次;2015、2016、2017年的肝移植术后医院感染率分别为15.73%,11.76%和10.84%;不同性别、年龄患者的术后医院感染率差异无统计学意义;感染患者感染例次最多的部位是下呼吸道,35例占51.47%,其次是腹腔,14例占20.59%;感染患者共分离出77株病原菌体,其中,革兰阴性杆菌39株占50.65%,革兰阳性菌21株占27.27%,真菌17株占22.08%;致病菌以鲍氏不动杆菌,铜绿假单胞菌和屎肠球菌为主。结论在研究年限内,医院肝移植术后医院感染发生率逐年下降,围手术期感染综合防控工作的持续改进和新术式的开展对于降低肝移植术后感染率有着积极的作用。

OBJECTIVE To analyze the epidemiological characteristics of nosocomial infection after liver transplantation,so as to provide a basis for development of prevention measures.METHODS Medical records of 391 inpatients with liver transplantation in a hospital in Guangzhou from Jan.2015to Dec.2017 were retrospectively investigated.The situation of nosocomial infection after liver transplantation was analyzed by descriptive study method. RESULTS Among the 391 patients,48 suffered from nosocomial infection (12.28%),1.42 times for each case. The infection rate after liver transplantation in our hospital was 15.73%,11.76% and 10.84%,respectively,in 2015,2016 and 2017.There was no significant difference in postoperative nosocomial infection rate among patients with different gender and age (P<0.05).The most frequent infection sites were lower respiratory tract (35cases, 51.47%)and abdominal cavity (14 cases,20.59%).A total of 77 strains of pathogens were isolated from the infected patients,with 39 strains of gram-negative bacillus (50.65%),21 strains of gram-positive bacteria (27.27%)and 17 strains of fungi (22.08%).The most common pathogenic bacteria were Acinetobacter baumannii,Pseudomonas aeruginosa and Enterococcus faecium.CONCLUSION The nosocomial infection rate after liver transplantation was decreasing in the studied years.Improvement of comprehensive perioperative infection prevention and control as well as employment of new operation methods played a positive role in reducing the infection rate after liver transplantation.