心胸外科ICU患者术后感染及相关因素分析

Analysis of postoperative infection and related factors in patients with cardiothoracic surgery ICU

目的探讨心胸外科ICU患者术后感染及相关危险因素。方法回顾性分析2016年7月~2018年7月湖南中医药大学第一附属医院心胸外科ICU收治的住院行手术治疗的患者240例,收集其临床资料(包括年龄、体外循环、气管插管时间、引流管放置时间、导尿管放置时间、手术时间、输血情况、深静脉置管时间)及医院感染监测资料,并进行系统的调查与分析。结果240例患者中有38例发生医院感染,感染率为15.83%。感染最常见的部位为呼吸道,共25例。检出病原菌59株,其中革兰阴性菌34株,革兰阳性菌15株,真菌10株。经多因素Logistic回归分析发现,患者的年龄、体外循环、气管插管时间、引流管放置时间等是引起术后感染的独立危险因素,差异有统计学意义(P<0.05)。术后感染的主要革兰阴性菌有鲍曼不动杆菌、肺炎克雷伯菌,其对头孢克肟、亚胺培南、环丙沙星、庆大霉素、氨苄西林、氨曲南的耐药率较高;革兰阳性菌主要有溶血葡萄球菌、表皮葡萄球菌、人血葡萄球菌,其对万古霉素、利奈唑胺敏感,但其对阿莫西林、阿奇霉素、拉氧头孢、美罗培南、头孢克肟、头孢氨苄的耐药率较高。结论心胸外科ICU患者术后感染率偏高,且导致患者发生感染的因素较多,临床应给予针对性干预。病原菌的耐药率偏高,临床应重视病原微生物检测,并根据细菌培养和药敏结果,合理使用抗菌药物。

Objective To investigate postoperative infection and related risk factors in patients with cardiothoracic surgery ICU.Methods A retrospective analysis was made on 240 patients admitted to ICU of Cardiothoracic Surgery,First Affiliated Hospital of Hunan University of Traditional Chinese Medicine from July 2016 to July 2018.The clinical data(including age,cardiopulmonary bypass,time of tracheal intubation,time of drainage tube placement,time of catheter placement,operation time,blood transfusion,time of deep vein catheterization)and monitoring funds of nosocomial infection were collected.The data were systematically investigated and analyzed.Results Hospital infection occurred in 38 of 240 patients,with an infection rate of 15.83%.The most common site of infection is the respiratory tract,a total of 25 cases.Fifty-nine strains of pathogens were detected,including 34 Gram-negative bacteria,15 Gram-positive bacteria,and 10 fungi.Multivariate Logistic regression analysis showed that age,extracorporeal circulation,tracheal intubation time,and drainage tube placement time were independent risk factors for postoperative infection,and the differences were statistically significant(P<0.05).The main Gram-negative bacteria were Acinetobacter baumannii and Klebsiella pneumoniae,which were more resistant to Cefixime,Imipenem,Ciprofloxacin,Gentamicin,Ampicillin and Aztreonam.Gram-positive bacteria were mainly Staphylococcus haemolyticus,Staphylococcus epidermidis and Staphylococcus hemorrhagicus.Gram-positive bacteria mainly include Staphylococcus haemolyticus,Staphylococcus epidermidis,and Staphylococcus aureus,which were sensitive to Vancomycin and Linezolid,but they were resistant to Amoxicillin,Azithromycin,Deoxycephalosporin,Meropenem,and Cefixime,with higher resistance rate.Conclusion The infection rate of ICU patients in cardiothoracic surgery is high,and there are many factors leading to infection.The clinical intervention should be given.The drug resistance rate of pathogenic bacteria is relatively high.Clinical attention should be paid to the detection of pathogenic microorganisms,and rational use of antibiotics should be based on the results of bacterial culture and drug sensitivity.