亲体肝移植术后医院感染流行病学调查与防控

Epidemiological investigation and control of nosocomial infections in patients undergoing prodonor liver transplantation

摘要:

目的研究亲体肝移植患者医院感染流行病学特征，探讨防控对策。方法采用回顾性调查的方法，对某院2007—2008年行亲体肝移植术的55例患者医院感染情况进行统计分析。结果55例亲体肝移植患者发生医院感染14例（25.45%），18例次（32.73%）；检出病原菌48株，主要为革兰阴性杆菌（32株，66.67%），其次是革兰阳性球菌（9株，18.75%）、真菌（7株，14.58%）。感染部位：肺部感染6例次，腹腔、胆道、上呼吸道感染各3例次，菌血症2例次，急性胃肠炎1例次。医院感染组住重症监护室（ICU）、术前用抗菌药物、使用呼吸机、静脉插管和肝周引流天数均显著多于未感染组（P＜0.05）。结论该院亲体肝移植患者术后感染率较低；其医院感染易感因素包括长时间住ICU和术前使用抗菌药物，而使用呼吸机、静脉插管和肝周引流时间长是其术后发生医院感染的侵入性因素。

Abstract:

ObjectiveTo study the epidemiological characteristics of nosocomial infections (NIs) in patients undergoing prodonor liver transplantation, so as to  evaluate the prevention and control measures.MethodsFiftyfive patients  undergoing prodonor liver transplantation in a hospital between  2007 and  2008  were analyzed statistically. ResultsAmong 55 patients, 14 patients  developed 18 cases  NIs, NI  rate was 25.45%, case infection rate was 32.73%. Forty-eight pathogenic strains were isolated ,the major strains were gramnegative bacilli(32 isolates,66.67%), followed by grampositive cocci(9 isolates,18.75%) and fungi(7 isolates,14.58%). The main infection site was lung(6 cases), followed by abdominal cavity(3), biliary tract (3), upper respiratory tract(3),bacteremia(2), and acute gastroenteritis(1). NI group had more days in intensive care unit (ICU) stay , preoperative antimicrobial application , use of ventilator and  venous catheter ,and perihepatic drainage than those of noninfection group (P<0.05). ConclusionPatients undergoing  prodonor liver transplantation have low postoperative infection rate; the susceptible factors for NI  include longterm ICU stay  and preoperative use of antimicrobial drugs, and the  invasive factors for postopereative NI are  long term  ventilator, intravenous catheter days and perihepatic drainage  .