体外膜肺氧合术后患者医院感染危险因素分析

Risk factors for healthcareassociated infection in patients after extracorporeal membrane oxygenation procedure

摘要:

目的了解接受体外膜肺氧合（ECMO）治疗患者术后发生医院感染情况，并分析相关危险因素。方法收集某院2003年1月—2012年12月应用ECMO辅助治疗患者的病历资料进行回顾性分析。结果43例接受ECMO治疗的患者术后发生医院感染15例（34.88％），24例次（55.81％）。医院感染部位以下呼吸道（12例次，50.00%）为主；其次是血液系统（6例次，25.00%）、皮肤和软组织（5例次，20.83%）等。分离病原体28株，其中革兰阴性杆菌19株（67.86%），革兰阳性球菌7株（25.00%），真菌2株（7.14%）；主要分离自痰标本（12株，42.86%），其次为血标本（9株，32.14%）和伤口分泌物标本（6株，21.43%）等。ECMO治疗患者术后医院感染的发生与患者年龄、ECMO辅助时间、并发症、呼吸机辅助呼吸、气管插管或切开、留置导尿管有关。结论接受ECMO治疗的患者术后医院感染率较高，医院应针对相关感染危险因素，采取有效的预防控制措施，减少ECMO术后医院感染的发生。

关键词:

体外膜肺氧合; 人工心肺; 医院感染; 危险因素; 病原菌; 感染部位

Abstract:

ObjectiveTo realize the incidence of healthcareassociated infection(HAI) in patients after receiving extracorporeal membrane oxygenation(ECMO)procedure, and to evaluate the related factors for HAI.MethodsClinical data of patients receiving ECMO from January 2003 to December 2012 were collected and analyzed retrospectively.ResultsOf 43 patients receiving ECMO, 15 （34.88％）developed 24 times（55.81％） of HAI. The main HAI site was lower respiratory tract（n=12,50.00%）,followed by blood stream（n=6，25.00%）,skin and soft tissue（n=5，20.83%）.A total of 28 isolates of pathogens were detected, gramnegative bacilli were 19（67.86%）isolates， grampositive cocci 7（25.00%）, and fungi 2（7.14%）; pathogens were mainly isolated from specimens of sputum（n=12，42.86%）, blood （n=9，32.14%）and wound secretion（n=6，21.43%）. The incidence of postoperative HAI in ECMO patients was related with patients’ age, duration of ECMO, complication, mechanical ventilation,tracheal intubation or tracheotomy, and indwelling urinary catheter.ConclusionHAI in patients receiving ECMO is high, hospital should take corresponding prevention and control measures targeting to the related risk factors of infection, so as to reduce the incidence of HAI after the ECMO.

Key words:

extracorporeal membrane oxygenation; artificial heartlung; healthcareassociated;risk factor; pathogen; infection site