鼻腔金黄色葡萄球菌定植与心脏手术后院内感染的关系  

Relationship between nasal colonization of Staphylococcus aureus and nosocomial infection after cardiac surgery

作　　者：虞敏[1] 毛建强[1] 孙菊芳[1] 袁忠祥[1] 

机构地区：[1]上海交通大学附属第一人民医院心血管外科,上海200080

出　　处：《上海交通大学学报（医学版）》2011年第4期473-476,共4页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的观察鼻腔金黄色葡萄球菌(SA)定植与心脏手术后院内感染的关系以及安尔碘Ⅲ鼻腔去定植治疗效果。方法心脏手术患者入院时行鼻腔拭子细菌学检测,有SA定植者随机分为治疗组和对照组,治疗组于术前3 d至术后3 d给予安尔碘Ⅲ鼻腔去定植治疗,对照组不予鼻腔去定植治疗,两组术后第3天复查鼻腔拭子;观察所有患者术后院内感染情况,分析鼻腔SA定植与术后院内感染的关系,比较两组患者细菌清除率以及术后院内感染发生率。结果 363例患者入选本研究,术后院内感染37例(10.2%)。入院时鼻腔SA定植率为9.4%,其中耐甲氧西林金黄色葡萄球菌(MRSA)鼻腔定植率为3.3%,鼻腔MRSA定植者术后院内感染发生率(41.7%)显著高于其他类型细菌定植者(P<0.05)。治疗组细菌清除率显著高于对照组(77.8%和50.0%,P<0.05);治疗组鼻腔MRSA定植者术后院内感染发生率低于对照组,但病例数少,无统计学意义。结论鼻腔MRSA定植者心脏手术后院内感染发生率显著增加,术前鼻腔安尔碘Ⅲ去定植治疗可能可以降低术后院内感染的发生率。Objective To observe the relationship between nasal colonization of Staphylococcus aureus(SA) and nosocomial infection after cardiac surgery,and investigate the efficacy of perioperative decolonization of nasopharynx with Anerdian Ⅲ. Methods Nasal bacterial cultures were performed by rubbing swabs at admission.Patients with SA colonization were randomly divided into decolonization group and control group.Patients in decolonization group were treated with Anerdian Ⅲ in nares,and those in control group were not.Nasal swabs were obtained and examined again on the third day after operation in both groups.The occurrence of postoperative nosocomial infection in all patients was observed,the relationship between nasal SA colonization and postoperative nosocomial infection was analysed,and the bacterial clearance rates and prevalences of postoperative nosocomial infection were compared between groups. Results A total of 363 patients were enrolled,and there was 37 patients(10.2%) with postoperative nosocomial infection.SA colonization rate at admission was 9.4%,and methicillin resistant Staphylococcus aureus(MRSA) was detected in 12 patients(3.3%).The prevalence of postoperative nosocomial infection in patients with MRSA(41.7%) was significantly higher than those in patients with the other bacterial colonization(P<0.05).The bacterial clearance rate in decolonization group was significantly higher than that in control group(77.8% vs 50%,P<0.05).In patients with MSRA,the prevalence of postoperative nosocomial infection in decolonization group was lower than that in control group,while there was no statistical significance due to limited cases. Conclusion The prevalence of postoperative nosocomial infection in patients with nasal MRSA colonization may increase.Decolonization with Anerdian Ⅲ may decrease the prevalence of postoperative nosocomial infection in MRSA carrier.

关 键 词：金黄色葡萄球菌 耐甲氧西林金黄色葡萄球菌 定植 心脏手术 医院感染 去定植 安尔碘 

分 类 号：R654.2[医药卫生—外科学]