Stanford A型主动脉夹层手术后多重耐药菌感染病原学特征及危险因素

Pathogenic characteristics and risk factors of multidrug-resistant organism infection after Stanford type A aortic dissection

目的探讨Stanford A型主动脉夹层(TAAD)手术后多重耐药菌(MDRO)感染的病原学特征及危险因素。方法回顾性分析2019年1月—2020年12月某胸科医院TAAD手术患者的病例资料,选取手术后MDRO感染患者为病例组,并按照1∶3进行病例-对照匹配,采用单因素和多因素logistic回归分析MDRO感染的影响因素。结果共调查578例TAAD手术患者,其中34例手术后发生MDRO感染,主要病原菌为肺炎克雷伯菌(28株,47.46%)、鲍曼不动杆菌(16株,27.12%)、铜绿假单胞菌(8株,13.56%)。匹配对照组非感染病例105例。单因素分析结果显示,病例组的手术持续时间、重症监护病房(ICU)住院时间、有创呼吸机使用时间、连续肾替代治疗构成比、术后肠道营养时间均高于对照组;病例组患者的输血量(红细胞、血小板、血浆)均高于对照组;差异均有统计学意义(均P<0.05)。多因素分析结果显示,ICU住院时间(OR=1.071)、有创呼吸机使用时间(OR=1.013)、连续肾替代治疗(OR=6.739)为TAAD术后MDRO感染的独立危险因素(均P<0.05)。结论TAAD手术后MDRO感染以革兰阴性菌为主,应尽量缩短患者呼吸机使用时间,保证肾供血,考虑及时进行有效的肾替代治疗减少并发症,减少ICU住院时间可降低手术后MDRO感染风险。

Objective To evaluate the pathogenic characteristics and risk factors of multidrug-resistant organism(MDRO)infection after Stanford type A aortic dissection(TAAD).Methods Medical data of TAAD patients in a thoracic hospital from January 2019 to December 2020 were retrospectively analyzed,patients with MDRO infection after operation were selected as case group,case-control matching was conducted according to 1∶3 matching,the influencing factors of MDRO infection were analyzed by univariate and multivariate logistic regression.Results A total of 578 patients with TAAD were investigated,34 of whom developed MDRO infection after operation.The main pathogens were Klebsiella pneumoniae(28 strains,47.46%),Acinetobacter baumannii(16 strains,27.12%)and Pseudomonas aeruginosa(8 strains,13.56%).105 non-infection cases were matched in control group.Univariate analysis showed that the duration of operation,length of stay in intensive care unit(ICU),duration of invasive ventilation,constituent ratio of continuous renal replacement therapy and duration of post-operative enteral nutrition in case group were all higher than those in control group;the amount of blood transfusion(red blood cells,platelets and plasma)in case group were all higher than control group;differences were all significant(all P<0.05).Multivariate analysis showed that the length of stay in ICU(OR=1.071),duration of invasive ventilation(OR=1.013)and continuous renal replacement therapy(OR=6.739)were independent risk factors for MDRO infection after TAAD operation(all P<0.05).Conclusion MDRO infection after TAAD operation is mainly Gram-negative bacterial infection,duration of invasive ventilation in patients should be shortened to ensure renal blood supply,timely and effective renal replacement therapy should be considered to reduce complications,shortening the length of stay in ICU can reduce the risk of MDRO infection after operation.