儿科体外膜肺氧合期间院内感染调查分析

The evaluation of nosocomial infections in pediatric extracorporeal membrane oxygenation support

目的分析体外膜肺氧合(ECMO)支持的儿科患者院内感染的临床因素。方法回顾分析2012年9月至2020年2月解放军总医院第七医学中心八一儿童医院和河南省人民医院ECMO支持患儿的一般资料、感染情况及感染相关因素,并对引起院内感染的相关因素进行分析。结果163例ECMO支持患儿中,36例(22.1%)患儿在ECMO支持期间发生了感染,共检出72株病原微生物,其中细菌67株(主要有鲍曼不动杆菌33株、肺炎克雷伯菌21株和铜绿假单胞菌6株),真菌5株。病原微生物来源于呼吸系统45例(62.5%)、血液系统25例(34.7%)、尿路1例(1.4%)、腹腔1例(1.4%)。鲍曼不动杆菌药敏结果显示为广泛耐药菌株。ECMO支持期间院内感染患儿ECMO支持时间[(10.0±6.7)d]、住院时间[(34.0±25.3)d]、住院治疗费用[(234368±113234)元]、术前氧合指数(52.8±23.0)和乳酸水平[(9.6±5.9)mmol/L]均较非感染患儿[(4.6±3.2)d、(24.3±19.8)d、(161416±65847)元、35.6±10.4、(5.6±5.4)mmol/L]高,差异均有统计学意义(均P<0.05)。ECMO支持期间院内感染患儿与未感染患儿死亡率相比,差异无统计学意义(P>0.05)。ECMO支持期间院内感染死亡患儿和存活患儿相比,乳酸水平和氧和指数均较高[9.8 mmol/L比2.7 mmol/L,36.0±12.7比22.1±10.4],差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,患儿ECMO支持时间(OR=7.054,95%CI:2.206~25.525)、术前乳酸水平(OR=2.250,95%CI:1.378~4.611)是院内感染的独立危险因素。结论纠正导致ECMO支持的基础疾病,缩短ECMO持续时间,可能降低ECMO支持患儿院内感染的发生率和病死率。

Objective To analyze clinical factors related to nosocomial infection in children with extracorporeal membrane oxygenation(ECMO)support.Methods General data,infection data and relevant factors in children with ECMO support in Bayi Children′s Hospital,the 7th Medical Center of People′s Liberation Army General Hospital and Henan Provincial People′s Hospital from September 2012 to February 2020 were reviewed.Relevant factors of nosocomial infection in them were analyzed.Results Among 163 cases,36(22.1%)children supported with ECMO had infections during the period of ECMO,and 72 pathogenic microorganisms were detected,including 67 bacteria(33 Acinetobacter baumannii,21 Klebsiella pneumoniae,and 6 Pseudomonas aeruginosa)and 5 fungi.Pathogens from the respiratory system,blood system,urinary tract and abdominal cavity were detected in 45 cases(62.5%),25 cases(34.7%),1 case(1.4%),and 1 case(1.4%),respectively.Drug sensitivity analysis of the Acinetobacter baumannii showed that it was the extensively resistant strain.Compared with uninfected children supported with ECMO,ECMO support time[(10.0±6.7)d],hospitalization[(34.0±25.3)d],hospitalization cost[(234368±113234)yuan],preoperative oxygenation index(52.8±23.0)and lactate value[(9.6±5.9)mmol/L]were significantly higher in nosocomial infection ones[(4.6±3.2)d,(24.3±19.8)d,(161416±65847)yuan,35.6±10.4,(5.6±5.4)mmol/L]supported with ECMO(all P<0.05).There was no significant difference in the mortality between 2 groups(P>0.05).In addition,lactate level(9.8 mmol/L)and oxygenation index(36.0±12.7)were significantly higher in died children(2.7 mmol/L,22.1±10.4)with nosocomial infection during the period of ECMO support than those of survivors(all P<0.05).Multivariate Logistic regression analysis showed that ECMO support time(OR=7.054,95%CI:2.206-25.525)and preoperative lactate value(OR=2.250,95%CI:1.378-4.611)were independent risk factors of nosocomial infection.Conclusions Correcting underlying diseases of ECMO supporting and shortening the duration of ECMO can reduce the incidence and mortality of nosocomial infection in children who are supported with ECMO.