先天性心脏病患儿医院感染病原菌特征与危险因素分析

Pathogen characteristics and risk factors analysis of nosocomial infections in children with congenital heart disease

目的探讨先天性心脏病患儿发生医院感染病原菌特征及危险因素,为降低医院感染提供参考。方法回顾性分析2011年1月-2014年1月住院的110例先天性心脏病患儿临床资料,记录患儿医院感染率、病原菌特征;探讨导致医院感染的独立危险因素。结果 110例先天性心脏病患儿共有12例发生医院感染,感染率为10.9%;其中下呼吸道、泌尿系统、胃肠道及手术部位感染分别占58.4%、25.0%、8.3%及8.3%;共分离出39株病原菌,其中革兰阴性菌23株占58.9%,革兰阳性菌15株占38.5%,真菌感染1株占2.6%;单因素分析显示,年龄≤3岁、机械通气时间>5d、抗菌药物使用>7次、心脏体外循环时间>120min、存在侵入性操作、住院时间>30d患儿是医院感染的相关危险因素(P<0.05)。结论先天性心脏病患儿医院感染病原菌主要是革兰阴性性菌;年龄、抗菌药物使用、侵入性操作、住院时间是医院感染的独立危险因素。

OBJECTIVE To explore the pathogenic characteristics and risk factors of nosocomial infections in children with congenital heart disease.METHODS Retrospective analysis of the clinical data of 110 cases of children with congenital heart disease from Jan.2011 to Jan.2014 in our hospital was conducted.The incidence of infection and pathogenic characteristics were recorded to investigate the independent risk factors for nosocomial infections.RESULTS In 110 cases of children with congenital heart disease,a total of 12 cases appeared nosocomial infections,and the infection rate was 10.9%;the lower respiratory tract infection in 7cases accounted for 58.4%;urinary system infection with 3cases accounted for 25.0%;1case of gastrointestinal infection accounted for8.3%,and operation site infection manifested in 1case accounted for 8.3%.Totally 39 strains of pathogenic bacteria were isolated,including 23 strains of gram-negative bacteria,accounting for 58.9%,and 15 strains of grampositive bacteria,accounting for 38.5%,and 1strain of fungi,accounting for 2.6%.Univariate analysis showed that age less than 3years old,mechanical ventilation time5d,antimicrobial use7cases,cardiopulmonary bypass time120min,invasive operation,hospitalization time30dwere related risk factors for children with the nosocomial infections（P〈0.05）.CONCLUSION The main pathogens causing nosocomial infections in children with congenital heart disease is gram-negative bacteria.Age,antibiotic use,invasive operation,hospitalization time are independent risk factors for nosocomial infections.