75岁以上高龄患者心脏手术后重症监护医院感染分析  

Analysis of nosocomial infection in elderly patients over 75 years old after cardiac surgery

作　　者：石秋霞[1,2] 闫晓蕾[1,2] 杜桂芳[1,2] 侯晓彤[1,2] 贾明[1,2] 贾世杰[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所心脏外科重症监护室,北京100029

出　　处：《心肺血管病杂志》2013年第5期576-579,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:调查重症监护病房高龄心脏手术患者术后医院感染及病原菌耐药性,以指导临床合理使用抗菌药物。方法:回顾性分析2005年1月至2012年10月,我院心脏外科75岁以上高龄患者术后医院感染临床资料,纸片扩散(K-B)法进行药敏实验。结果:2005年1月至2012年10月75岁以上高龄患者行开胸心脏手术1 361例,100例患者发生医院感染,感染率7.3%。合并糖尿病患者医院感染发生率显著高于非糖尿病患者;发生医院感染的高龄心脏手术患者住院时间、住院费用及病死率显著高于未发生医院感染的高龄患者。分离各种病原菌165株,其中呼吸道101株,占61.2%;血液29株,占17.6%;其他各类病原菌35株,占21.2%。革兰氏阴性菌中以鲍曼不动杆菌为主(20.6%),革兰氏阳性菌中以表皮葡萄球菌为主(7.2%),真菌中以白色假丝酵母菌为主(22.4%)。鲍曼不动杆菌显示多种药物为100%耐药。溶血性葡萄球菌及金黄色葡萄球菌显示多药耐药。呋喃妥因及万古霉素对革兰氏阳性球菌抗菌活性均为100%。结论:高龄心脏手术患者术后医院感染主要发生在呼吸道,耐药性逐渐增加,围手术期应合理使用抗菌药物,减轻患者负担,降低高龄患者住院病死率。Objective：To investigate the clinical distribution and antibiotics resistance of nosocomial pathogenic bacteria infection in elderly patients in ICU after cardiac surgery, in order to guide the clinical ra- tional use of antibiotics. Methods： The clinical data of hospital infection in patients over 75 years old from Jan- uary 2005 to October 2012 after cardiac surgery were retrospectively analyzed. Antibacterials susceptibility tes- ting was performed by Kirby-Bauer method. Results： There were 1 361 patients over 75 years old underwent cardiac surgery from January 2005 to October 2012, including 100 cases of these patients with hospital infec- tion, the infection rate was 7. 3%. The nosocomial infection rate in patients with diabetes was significantly higher than that in non-diabetic patients. The time of hospitalization, cost of hospitalization and mortality of eld- erly patients with nosocomial infection after heart operations were significantly higher than those of elderly pa- tients with non nosocomial infection. 165 strains of pathogenic bacteria were isolated, including 101 strain~ from respiratory tract （61.2%）; 29 strains from blood （17.6%）; other types were 35 strains, accounting for 21.2%. The majority of gram negative bacteria were acinetobacter （20. 6% ）. In gram positive bacteria, Staphylococcus epidermis was the most （7.2%）. The proportion of Candida albicans in fungus was 22. 4%. The resuh of bauman acinetobacter resistance showed that multidrug resistance was 100%. Staphylococcus hae- molyticus and Staphylococcus aureus showed multidrug resistance. The antibacterial activity of nitrofurantoin

关 键 词：心脏外科手术 医院感染 重症监护 高龄 

分 类 号：R54[医药卫生—心血管疾病]