器官移植患者术后医院感染的影响因素

Influencing factors for nosocomial infection in patients after organ transplantation

目的探讨器官移植患者术后发生医院感染的影响因素。方法回顾性分析中山市人民医院2012年1月-2018年12月共579例器官移植手术患者的医院感染资料,分析感染患者感染情况,检出病原菌,并归纳器官移植患者术后医院感染的影响因素。结果579例器官移植患者术后医院感染48例(71例次),感染率为8.29%(48/579),感染部位主要为下呼吸道35例次(49.30%)、其次血液系统18例次(25.35%),泌尿系统感染11例次(15.49%)为主。共培养分离病原菌63株,其中革兰阴性菌40株占63.49%,主要为耐碳青霉烯类鲍氏不动杆菌、嗜麦芽寡养单胞菌、产ESBLs细菌、洋葱伯克霍尔德菌、耐碳青霉烯类铜绿假单胞菌等;革兰阳性菌14株占22.22%,以肠球菌、耐甲氧西林金黄色葡萄球菌为主;真菌9株占14.29%。年龄、术后ICU滞留时间、呼吸机辅助呼吸、侵入性操作是器官移植术后医院感染的影响因素(P<0.05)。结论医院应针对感染的影响因素,采取相应的预防措施,加强基础感控与精准感控工作,减少移植术后医院感染的发生。

OBJECTIVE To analyze the influencing factors of nosocomial infection in patients after organ transplantation.METHODS Retrospective collection,analysis of the nosocomial infection data of 579patients with organ transplant in Zhongshan People′s Hospital from Jan.2012to Dec.2018were retrospectively analyzed,the infection status of infected patients were analyzed,the pathogenic bacteria were detected and the influencing factors of nosocomial infection in patients after organ transplantation were summarized.RESULTS There were 48patients(71cases)of nosocomial infections in 579cases of organ transplant patients,the infection rate was 8.29%,the main infection sites were the lower respiratory tract in 35cases(49.30%),followed by the blood system in 18cases(25.35%),and the urinary tract system infection in 11cases(15.49%).63strains of pathogenic bacteria were isolated by co-cultivation,of which 40strains of gram-negative bacillus accounted for 63.49%,mainly carbapenem-resistant Acinetobacter baumannii,Stenotrophomonas maltophilia,ESBLs-producing bacteria,Burkholdenia cepacia,carbapenem-resistant Pseudomonas aeruginosa and so on;14strains of gram positive coccus accounted for 22.22%,mainly Enterococcus and methicillin-resistant Staphylococcus aureus;9strains of fungi accounted for 14.29%.Age,postoperative ICU stay time,ventilator assisted breathing,and invasive operations were the influencing factors of nosocomial infection after organ transplantation.CONCLUSION Hospitals should take corresponding preventive measures against the influencing factors of infection,strengthen basic and precise sensory control,and reduce the incidence of nosocomial infections after liver transplantation.