风湿性心脏病患者术后切口感染的病因及病原菌特征

Etiology and pathogenic bacteria characteristics of postoperative wound infection in patients with rheumatic heart disease

目的探讨风湿性心脏病患者术后切口感染的病因及病原菌特征。方法选取2018年6月-2020年11月本院收治的风湿性心脏病患者184例,根据感染与否分为感染组和未感染组。采集受试者血液进行病原菌的分离鉴定,分析病原菌的分布特点以及主要病原菌的耐药情况。采用单因素和多因素Logistic回归法分析风湿性心脏病患者术后切口感染发生的危险因素。结果184例风湿性心脏病患者中术后发生切口感染64例(34.78%),共检测出98株病原菌,其中革兰阳性菌56株,革兰阴性菌36株,真菌6株,主要感染病原菌为金黄色葡萄球菌(20株)、链球菌(16株)和鲍曼不动杆菌(12株)。金黄色葡萄球菌、链球菌菌属均表现出较高的青霉素耐药性,耐药率均>90%,利奈唑胺、万古霉素的耐药率低于6%。两组患者的年龄、病程、住院天数、抗菌药使用情况、手术方式以及手术动脉阻断时间比较差异均有统计学意义(P<0.05或P<0.01);Logistic回归分析显示,年龄、病程、住院天数、手术动脉阻断时间、抗菌药使用、手术方式均是风湿性心脏病患者术后切口感染的独立危险因素(均P<0.05)。结论风湿性心脏病患者术后切口感染与多种因素有关,感染病原菌以革兰阳性菌为主,且主要感染病原菌对青霉素、红霉素具有较高耐药性,因此临床上应关注病原菌的耐药特点。

Objective To investigate the etiology and pathogenic bacteria characteristics of postoperative wound infection in patients with rheumatic heart disease.Methods 184 patients with rheumatic heart disease admitted to our hospital from June 2018 to November 2020 were selected.They were divided into infected group and uninfected group according to the infection.The blood of subjects was collected for isolation and identification of pathogens,and the distribution characteristics of pathogens and drug resistance of main pathogens were analyzed..Univariate and multivariate logistic regression were used to analyze the risk factors of postoperative wound infection in patients with rheumatic heart disease.Results Among 184 patients with rheumatic heart disease,64 cases(34.78%)had postoperative incision infection.98 strains of pathogens were detected,including 56 strains of Gram-positive bacteria,36 strains of Gram-negative bacteria and 6 strains of fungi.The main pathogens were 20 strains of Staphylococcus aureus,16 strains of Streptococcus and 12 strains of Acinetobacter baumannii.Staphylococcus aureus and Streptococcus showed high resistance to penicillin,the resistance rate was more than 90.00%,and the resistance rate to linezolid and vancomycin was less than 6.00%.There were significant differences in age,course of disease,length of hospital stay,use of antibiotics,operation methods and arterial occlusion time between the two groups(P<0.05 or P<0.01).Logistic regression analysis showed that age,course of disease,length of hospital stay,duration of arterial occlusion,use of antibiotics and operation methods were the influencing factors of postoperative wound infection in patients with rheumatic heart disease(P<0.05).Conclusion Postoperative incision infection in patients with rheumatic heart disease is related to many factors.The main pathogens are Gram-positive bacteria,and the main pathogens are highly resistant to penicillin and erythromycin.Therefore,clinical attention should be paid to the drug resistance of pathogens.