成人心脏术后患者体外膜肺氧合治疗相关医院感染的危险因素及病原学分析

Risk factors and pathogen distribution of nosocomial infection in adult patients undergoing extracorporeal membrane oxygenation after cardiac surgery

目的分析成人心脏外科术后患者体外膜肺氧合(Extracorporeal membrane oxygenation,ECMO)支持治疗相关医院感染的危险因素,并对其病原学进行分析。方法回顾性分析2012年1月至2017年12月在北京安贞医院成人心脏外科术后接受ECMO支持治疗325例患者的临床资料。所有患者根据是否发生相关医院感染分为感染组(n=132)和非感染组(n=193)。应用多因素Logistic回归分析成人心脏术后患者体外膜肺治疗发生相关医院感染的危险因素,并对感染患者的病原菌分布进行分析。结果 325例患者中,继发医院感染132例,感染率为40.62%。其中发生呼吸道感染67例(50.76%),血液感染40例(30.30%),手术切口感染15例(11.36%),泌尿道感染10例(7.58%)。感染组患者的病死率为61.37%(81/132),非感染组患者的病死率为52.85%(102/193),两组比较差异具有统计学意义(χ^2=6.356,P<0.05)。单因素分析显示,手术时间长、应用体外循环和ECMO支持治疗时间长均是成人心脏术后ECMO治疗发生相关医院感染的危险因素。多因素Logistic回归分析发现,ECMO治疗时间(OR=5.565,95%CI=2.868~10.799,P<0.01)是成人心脏术后ECMO治疗继发医院感染的独立危险因素。132例感染患者中,共检出病原菌364株,其中革兰阴性菌233株,以鲍曼不动杆菌株(79/233,33.9%)和肺炎克伯雷杆菌(32/233,13.73%)为主;革兰阳性菌101株,甲型链球菌、微球菌和卡他球菌各占14.85%(15/101);真菌30株,白假丝酵母菌占70%(4/30)。结论 ECMO支持时间是成人心脏术后ECMO治疗发生相关医院感染的独立危险因素,病原菌以革兰阴性菌为主。

Objective To analyze the risk factors and pathogen distribution of nosocomial infection in adult patients undergoing extracorporeal membrane oxygenation (ECMO) after cardiac surgery. Methods The clinical data of 325 patients who underwent ECMO support in the Department of Adult Cardiac Surgery of Beijing Anzhen Hospital from January 2012 to December 2017 were retrospectively analyzed. There were 132 patients with nosocomial infection (infected group) and 193 patients without nosocomial infection (non-infected group). Multivariate logistic analysis was used to analyze the risk factors of nosocomial infection, and the distribution of pathogens in infected patients was also analyzed. Results Among 132 infected patients, 67 cases (50.76%) had respiratory infection, 40 cases (30.30%) had blood infection, 15 cases (11.36%) had surgical wound infection, and 10 cases (7.58%) had urinary tract infection. The case fatality rates of the infected group and non-infected group were 61.37%(81/132) and 52.85%(102/193), respectively (χ^2=6.356, P<0.05). Univariate analysis showed that long operation time, application of extracorporeal circulation and long-term ECMO support were associated with nosocomial infection. Multivariate logistic regression analysis found that ECMO time (OR=5.565, 95% CI=2.868-10.799, P<0.01) was an independent risk factor for nosocomial infection after ECMO treatment in adult patients after cardiac surgery. Among the 132 infected patients, 364 strains of pathogens were detected, of which 233 were Gram-negative bacteria, including 79 strains of Acinetobacter Baumann (33.9%) and 32 strains of K. pneumoniae (13.73%);101 strains were Gram-positive bacteria, including Streptococcus aureus (14.85%), Micrococcus (14.85%) and catarrhal bacteria (14.85%);30 strains were fungi and Candida albicans accounted for 70% of fungi infections. Conclusion The long ECMO support time is an independent risk factor for ECMO-related hospital infections in adult patients undergoing cardiac surgery, and the pathogens are mainly Gram-negative bacteria.