急性心肌梗死患者急诊冠脉介入治疗术后医院感染病原学分析

Etiological analysis of nosocomial infections in emergency hospitalized patients with acute myocardial infarction after coronary intervention surgery

目的探讨急诊冠脉介入治疗急性心肌梗死术后住院患者医院感染的病原学情况,为临床治疗提供参考依据。方法选取2013-2015年在医院行急诊冠脉介入术治疗急性心肌梗死的住院患者268例为临床研究对象,采用回顾性调查的方法,对患者住院期间的医院感染情况、感染部位分布、病原菌分布及对抗菌药物的耐药情况进行统计分析。结果 268例患者中发生医院感染46例,感染率17.16%;感染部位以呼吸系统为主,共26例占56.52%;共分离出224株病原菌,以革兰阴性菌为主,共170株占75.89%;革兰阴性菌对氨苄西林、哌拉西林和环丙沙星等抗菌药物耐药,对头孢哌酮/舒巴坦、阿米卡星、氨曲南、亚胺培南及左氧氟沙星等抗菌药物敏感。结论在冠脉介入治疗急性心肌梗死患者的治疗中,应增加患者的营养补给,提高自身免疫力,规范手术操作,合理应用抗菌药物,进而降低患者医院感染率。

OBJECTIVE To investigate the etiology of nosocomial infection in emergency hospitalized patients with acute myocardial infarctions after coronary intervention surgery, so as to provide references for clinical treatment. METHODS From Jan. 2013 to Dec. 2015, 268 emergency hospitalized patients with acute myocardial infarction and coronary intervention surgery were selected as clinical study subjects. By retrospective survey, the nosocomial infection, distribution of infection sites, distribution of pathogens and antimicrobial resistance of the hospitalized patients were statistically analyzed. RESULTS In the 268 emergency hospitalized patients with acute myocardial in- farction and coronary intervention surgery, there were 46 patients with nosocomial infectlons, with the nosocomial infection rate of 17.16 0/~. In the 46 patients with nosocomial infections, respiratory system infection （26 cases） was the main infection site, accounting for 56.52o//00. Totally 224 strains of pathogenic bacteria were isolated from 46 patients with nosocomial infections. The gram-negative bacteria （170 strains） were the main pathogens, ac- counting for 75.89~. The gram-negative bacteria were resistant to antibacterial drugs, including ampicillin, pip- eracillin and ciprofloxacin, and sensitive to antibacterial drugs, including cefoperazone/sulbactam, amikacin, az- treonam, imipenem and levofloxacin. CONCLUSION In the treatment of acute myocardial infarction patients with coronary intervention, we should increase the nutritional supply of patients to improve their immunity, standardize surgical procedures, and rationally use antimicrobial drugs, so as to decrease nosocomial infection rate in patients.