儿科体外膜肺氧合期间院内感染防控

Prevention and control of nosocomial infection during extracorporeal membrane oxygenation in pediatric patients

体外膜肺氧合(ECMO)是一种应用于呼吸衰竭和循环衰竭重症患儿的有创的、挽救性的生命支持技术。ECMO期间院内感染是ECMO的严重并发症之一,其发生率为16.6%~22.1%,研究发现ECMO支持时间是院内感染的独立危险因素,院内感染对ECMO患者预后和病死率的影响尚不确定。凝固酶阴性葡萄球菌、念珠菌、肠杆菌是ECMO期间院内感染的常见致病菌,预防性使用抗菌药物是常见做法。ECMO期间抗菌药物的药代动力学发生变化,要根据药物浓度测定结果调整其剂量。

Extracorporeal membrane oxygenation (ECMO) is an invasive,lifesaving life-support technique for critically ill children with respiratory and circulatory failure.Nosocomial infection during ECMO is one of the serious complications of ECMO,and the incidence rate of nosocomial infection during pediatric ECMO is 16.6%-22.1%.Studies have found that the duration of ECMO support is an independent risk factor for nosocomial infection.The effect of nosocomial infection on prognosis and mortality in ECMO patients is uncertain.Coagulasenegative staphylococcus,candida and enterobacter are common pathogenic bacteria of nosocomial infection during ECMO,and prophylactic use of antibiotics is a common practice.The pharmacokinetics of antibiotics changes during the period of ECMO assistance,and the dosage should be adjusted according to the results of drug concentration determination.