体外循环心血管手术后医院感染回顾性分析

A retrospective analysis on healthcareassociated infection in patients after extracorporeal circulation operations

摘要:

目的了解某院体外循环心血管手术患者术后医院感染发生情况及流行病学特征。方法对该院心血管外科2010年9月—2011年12月间的731例体外循环手术患者术后医院感染情况进行回顾性调查。结果731例体外循环心血管手术患者发生医院感染87例、103例次，医院感染率和例次感染率分别为11.90%、14.09%。不同心血管疾病医院感染率：先天性心脏病为9.74%，风湿性心脏病为10.69%，其他心血管疾病为31.82%，差异有统计学意义（χ2=27.54，P＜0.05)。医院感染部位以下呼吸道为主，占72.82%；其次为血液系统14.56％，泌尿系统7.77％，胸膜腔和胃肠道各1.94%，手术部位0.97%。病原学送检率为35.57%（260/731），检出病原菌112株，其中革兰阴性菌89株（79.46%），革兰阳性菌18株（16.07%），真菌5株（4.46%）；检出多重耐药鲍曼不动杆菌28株，耐甲氧西林金黄色葡萄球菌3株，耐甲氧西林凝固酶阴性葡萄球菌7株，肺炎克雷伯菌和大肠埃希菌均为产超广谱β内酰胺酶（ESBLs）株。结论体外循环心血管手术患者术后医院感染率高，分离的病原菌耐药性强，应加强监控，采取有效措施降低医院感染率。

Abstract:

ObjectiveTo investigate the occurrence and  epidemiological characteristics of healthcareassociated infection (HAI) in patients with extracorporeal circulation operations.MethodsClinical data of 731 patients with extracorporeal circulation operations in a hospital from September 2010 to December 2011 were studied retrospectively.ResultsOf 731 patients ,  87 developed 103 episodes of HAI, HAI rate and episode rate was  11.90% and 14.09% respectively . HAI  rate in patients with  congenital heart disease, rheumatic heart disease and other cardiovascular disease was 9.74%, 10.69%, and 31.82% respectively（χ2=27.54，P＜0.05) .  The most common infection site was lower respiratory tract (72.82%), followed by blood stream  (14.56%), urinary system (7.77%), pleural cavity (1.94%), gastrointestinal tract (1.94%), and  surgical sites (0.97%).   The pathogenic examination rate was 35.57%（260/731） ,  112 pathogenic strains were isolated , 89 (79.46%) of which were gramnegative bacteria ,18 (16.07%) were  grampositive bacteria  and 5 (4.46%) were fungi .There were 28 isolates of  multidrugresistant Acinetobacter baumannii, 3 methicillinresistant Staphylococcus aureus and 7 methicillinresistant coagulase negative Staphylococcus, all Klebsiella pneumonia and Escherichia coli isolates were βlactamaseproducing strains.ConclusionHAI rate in patients with  extracorporeal circulation operations are high, drug resistance of pathogen is high, monitor should  be intensified to reduce the occurrence  of HAI.