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

作　　者：方清永[1] 刘丁[1] 陈萍[1] 王政[1] 黄庆宁[1] 南玲[1] 成瑶[1] 王豪[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所重庆市感染控制中心,重庆400042

出　　处：《中国感染控制杂志》2013年第1期47-49,共3页Chinese Journal of Infection Control

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。Objective To investigate the occurrence and epidemiological characteristics of heahhcare-associated in- fection （HA1） in patients with extracorporeal circulation operations. Methods Clinical data of 731 patients with ex- tracorporeal circulation operations in a hospital from September 2010 to December 2011 were studied retrospective- ly. Results Of 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 cardio- vascular disease was 9. 74%, 10. 69%, and 31.82% respectively（X^2= 27. 54,P〈0. 05） . The most common infec- tion 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 multi- drug-resistant Acinetobacter baumannii, 3 methicillin-resistant Staphylococcus aureus and 7 metbicillin-resistant co- agulase negative Staphylococcus, all Klebsiella pneumonia and Escherichia coli isolates were β-1actamase-producing strains. Conclusion HA1 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.

关 键 词：体外循环手术 心血管手术 医院感染 危险因素 感染控制 

分 类 号：R181.32[医药卫生—流行病学]