以急性心肌梗死入院患者发生感染的致病菌特点和危险因素分析

Analysis of pathogens and risk factors of infection of patients with acute myocardial infarction

目的了解以急性心肌梗死(AMI)入院的患者的临床特征,发生感染的特点和致病菌种类,以及与感染相关的危险因素分析。方法回顾性调查某三甲医院2017年7月—2018年7月55例由于发生急性心肌梗死入院患者的基本资料、基础疾病、住院情况,治疗措施,感染特点等因素,并对纳入调查的因素用SPSS 20.0进行单因素分析。结果 55例患者送检微生物培养中,阳性检出共25个样本,感染部位主要是呼吸道(64%)和血液(28%)。发生感染的患者有22例(40%),感染发生率较高。有6例样本出现混合感染(检出≥2株菌),包括5例呼吸道样本和1例血液样本,有2例患者在多个部位出现感染。培养共检出33株致病菌,以非发酵菌为主,鲍曼不动杆菌(45.6%)居第一位。单因素分析显示使用呼吸机(或气管切开)与发生感染显著相关(P值<0.00),入ICU、使用抗生素、住院天数>15天、深静脉置管、尿管也和感染发生明确相关性(P<0.05)。结论急性心肌梗死患者发生感染的危险因素和入院后发生侵入性操作呈显著正相关,住院时间延长,尤其是入ICU的重症患者也是发生感染的高危因素;感染菌主要是鲍曼不动杆菌,是医院内感染常见菌,提示医护人员对于急性心肌梗死患者应提高医院内感染的防控意识,对需进行侵入性治疗操作的患者应制定防感控感措施。

Objective To understand the clinical characteristics,the types of infection and pathogenic bacteria,and the risk factors in patients with acute myocardial infarction(AMI).Methods A retrospective survey was conducted on the clinical data of 55 patients with AMI from July 2017 to July 2018 in a third-class hospital,including the basic data,basic diseases,hospitalizations,treatment measures,infection characteristics and other factors.SPSS 20.0 single factor analysis was performed on the factors included in the survey.Results Totally 25 positive samples were detected in 55 patients,the main infection sites were respiratory tract(64%) and blood(28%).22 patients(40%) were infected,the incidence of infection was high.There were 6 cases of mixed infection(≥ 2 strains),including 5 cases of respiratory tract samples and 1 case of blood sample.There were 2 patients developed infection in multiple sites.A total of 33 pathogenic bacteria were isolated,mainly non-fermenting bacteria,Acinetobacter baumannii(45.6%) was the first.Single factor analysis showed that the ventilator(or tracheotomy) was significantly correlated with infection(P<0.00),in ICU,antibiotics use,hospital stay>15 days,deep venous catheterization,urinary catheter were also correlated with infection(P<0.05).Conclusion The significant risk factor of infection in patients with acute myocardial infarction is the invasive operation,and Prolonged hospitalization,especially in ICU,is also the risk factor for infection.The mainly infective pathogen,acinetobacter baumannii,is common in hospital acquired infection.It suggests that medical staff should improve the awareness of prevention and control of nosocomial infection with AMI,especially the patients with the invasive operation.