ECMO支持治疗患者医院感染巢式病例对照研究

A nested case-control study of healthcare-associated infections in patients receiving ECMO supportive treatment

目的分析体外膜肺氧合(ECMO)支持治疗患者医院感染流行病学特点及医院感染危险因素.方法选取2017年2月-2022年4月湖北医药学院附属太和医院收治的ECMO支持治疗患者为研究对象,根据是否发生医院感染分为感染组和非感染组,统计感染部位及病原菌分布,单因素和多因素Logistic回归分析ECMO支持治疗患者发生医院感染的危险因素.结果共68例ECMO支持治疗患者纳入研究,平均年龄为(45.78±15.83)岁,男性55例(80.9%),60例患者行V-A模式;17例(25.00%)患者发生28例次医院感染,感染部位以呼吸系统(12例次,42.86%)为主,其次为血液系统(7例次,25.00%);中心ICU感染例次率最高(17例次,58.62%);共检出病原菌45株,以革兰阴性菌为主(30株,66.67%),检出菌中多药耐药菌29株占64.44%;多因素Logistic回归分析显示,ECMO支持治疗时长是ECMO支持治疗患者发生医院感染的独立危险因素(OR=1.945,95%CI=1.067~3.546,P=0.030).结论ECMO支持治疗患者医院感染发病率高,ECMO支持治疗时长为其危险因素;应开展综合防治措施,降低ECMO支持治疗患者医院感染率.

OBJECTIVE To explore the etiological characteristics and risk factors for nosocomial infection in the patients receiving extracorporeal membrane oxygenation(ECMO)supportive treatment.METHODS The patients who received ECMO supportive treatment in Taihe Hospital Affiliated to Hubei University of Medicine from Feb 2017 to Apr 2022 were recruited as the research subjects and were divided into the infection group and the non-infection group according to the status of nosocomial infection.The infection sites and species of pathogens were statistically analyzed.Univariate analysis and multivariate logistic regression analysis were performed for the risk factors for the nosocomial infection.RESULTS A total of 68 patients who underwent the ECMO supportive treatment were enrolled in the study,the mean age was(45.78±15.83)years old,55 patients were male,accounting for 80.9%,and 60 patients underwent V-A model.17(25.00%)patients had 28 case-times of nosocomial infection,there were 12(42.86%)case-times of respiratory system infection and 7(25.00%)case-times of blood system infection.There were 17(58.62%)case-times of central ICU infection.Totally 45 strains of pathogens were isolated,30(66.67%)of which were gram-negative bacteria;29(64.44%)strains of multidrug-resistant organisms were isolated.The multivariate logistic regression analysis showed that the duration of ECMO supportive treat-ment was the independent risk factor for the nosocomial infection(OR=1.945,95%CI=1.067-3.546,P=0.030).CONCLUSION The incidence of nosocomial infection is high among the patients receiving ECMO supportive treatment,and the duration of ECMO supportive treatment is the risk factor.It is necessary to carry out comprehensive prevention measures so as to reduce the incidence of nosocomial infection in the patients receiving ECMO supportive treatment.