心脏术后患者医院感染病原学特点及危险因素分析

Etiological characteristics and risk factors of nosocomial infections after cardiac surgery

目的研究心脏术后医院感染的病原学特点及危险因素。方法回顾性分析2005年1月-2015年12月在医院接受心脏及大血管手术的573例患者,对患者术后医院感染病原学特点及危险因素进行统计分析。结果患者发生院内感染例数为74例,感染率为12.91%,其中呼吸道感染最为常见。共检测出病原菌158株,其中革兰阴性菌为80株占50.63%,革兰阳性菌为48占30.38%,真菌30株占18.99%。革兰阳性菌对红霉素、青霉素、庆大霉素等药物耐药性较高,其中青霉素、庆大霉素耐药率为100%,对利奈唑胺、替考拉宁及万古霉素高度敏感,耐药率为0。革兰阴性菌对头孢丙烯、阿米卡星、头孢呋辛等药物耐药率较高,对美罗培南、亚胺培南及环丙沙星有很高的敏感,有些耐药率为0。通过对感染因素分析,患者的年龄、糖尿病、手术时间、术后二次手术、呼吸机使用时间、深静脉留置时间、导尿管留置时间、术后24h输血浆量、术后24h输少浆血量等因素差异,是引发患者出现院内感染的危险因素(P<0.05)。结论医院应针对危险因素及患者病原学特点制定针对性的防控措施,促进患者预后。

OBJECTIVE To investigate the etiological characteristics and risk factors of nosocomial infections after cardiac surgery.METHODS A total of 573 patients with cardiac and vascular surgery from Jan.2005 to Dec.2015 in our hospital were retrospectively analyzed.The etiological characteristics and risk factors of nosocomial infections were statistically analyzed.RESULTS There were 74 cases of nosocomial infections,and the infection rate was12.91%,among which respiratory tract infection was the most common.A total of 158 strains of pathogenic bacteria were detected,including 80 strains of gram-negative bacteria,accounting for 50.63%,48 strains of grampositive bacteria,accounting for 30.38%,and 30 strains of fungi,accounting for 18.98%.The resistant rates of gram-positive bacteria to erythromycin,penicillin,gentamicin and other drugs were high,which topenicillin and gentamicin were 100%,and gram-positive bacteria were highly sensitive to linezolid,teicoplanin and vancomycin,and the drug resistant rates were 0%.The resistant rates of gram-negative bacteria to cefprozil,amikacin and cefuroxime were high,and gram-negative bacteria had highly sensitive rates to meropenem,imipenem and ciprofloxacin,and some drug resistant rates were 0%.Through the analysis of factors of infections,age,diabetes,operation time,postoperative second surgeries,ventilator time,indwelling time,catheter indwelling time,postoperative 24 Htransfusions of plasma volume,and postoperative 24 Hloss less blood plasma were risk factors of nosocomial infection in patients.CONCLUSION Hospitals should develop targeted prevention and control measures to promote the prognosis of patients according to risk factors and etiological characteristics of the patients.