心脏外科术后患者深部胸骨切口感染的临床特征与病原菌分布及耐药性研究  

Clinical characteristics of postoperative deep sternal wound infection in patients undergoing cardiac surgery and distribution and drug resistance of pathogens

作　　者：周丹[1] 陶凉[1] 陈绪发[1] 周宏[1] 杨凯[1] ZHOU Dan TAO Liang CHEN Xu-fa ZHOU Hong YANG Kai(Wuhan Asian Heart Disease Hospital, Wuhan , Hubei 430022, Chin)

机构地区：[1]武汉亚洲心脏病医院心外科,湖北武汉430022

出　　处：《中华医院感染学杂志》2017年第5期1117-1120,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨心脏外科术后患者深部胸骨切口感染的临床特征、病原菌分布及耐药性的情况,为临床诊疗提供理论依据。方法回顾性分析医院收治的心脏外科手术后深部胸骨切口感染患者69例;对比不同临床分型的深部胸骨切口感染患者的临床表现、实验室检查以及影像学检查结果;分析深部胸骨切口感染的病原菌分布及主要病原菌的耐药性情况。结果Ⅲ型深部胸骨切口感染体温≥38℃的比例、自发性疼痛的比例、白细胞计数>10×109/L的比例均显著低于Ⅰ型和Ⅱ型深部胸部切口感染(P<0.05);Ⅲ型深部胸骨切口感染术口裂开或见脓性分泌物的比例显著低于Ⅱ型深部胸骨切口感染(P<0.05);Ⅲ型深部胸骨切口感染低蛋白血症的比例显著低于Ⅰ型深部胸骨切口感染(P<0.05);本研究共培养出病原菌76株,其中,革兰阴性菌42株(55.26%),革兰阳性菌30株(39.47%),真菌4株(5.26%);铜绿假单胞菌对头孢他啶、头孢吡肟、亚胺培南和美罗培南均有较高的敏感性,耐药率均为16.67%;鲍曼不动杆菌对临床常用的抗菌药物均表现出高度的耐药性;金黄色葡萄球菌和表皮葡萄球菌对青霉素G和克拉霉素均表现出高度的耐药性,而对替加环素、利奈唑胺和万古霉素均敏感,耐药率均为0.00%。结论心脏外科术后应密切观察患者的病情变化,及早发现深部胸骨切口感染并规范应用抗菌药物,改善患者的预后。OBJECTIVE To explore the clinical characteristics of postoperative deep sternal wound infection in patients undergoing cardiac surgery and analyze the distribution and drug resistance of pathogens so as to provide theoretical basis for clinical diagnosis and treatment. METHODS A total of 69 patients who had deep sternal wound infection after cardiac surgery were retrospectively analyzed. The clinical manifestations and results of clinical la- boratory test and imaging examination were compared among the patients with different clinical stages of deep sternal wound infection; the distribution of the pathogens causing the deep sternal wound infection was analyzed, and the drug resistance of the major species of pathogens was observed. RESULTS The proportions of the patients with the body temperature no less than 38℃, spontaneous pain, and white blood cell counts more than 10×109/L were remarkably less in the patients with type Ill deep sternal wound infection than in the patients with type I and II deep sternal wound infection （P〈0. 05）. The proportion of the patients with postoperative wound dehiscence or purulent secretions was significantly less in the patients with type Ⅲ deep sternal wound infection than in the pa- tients with type Ⅱ deep sternal wound infection （P〈0.05）. The proportion of the patients with hypoproteinemia was remarkably less in the patients with type Ⅲ deep sternal wound infection than in the patients with type I deep sternal wound infection （P〈0. 05）. Totally 76 strains of pathogens were isolated, including 42 （55.26%） strains of gram-negative bacteria, 30 （39.47%） strains of gram-positive bacteria, and 4 （5.26%） strains of fungi. The Pseudomonas aeruginosa strains were highly susceptible to ceftazidime, cefepime, imipenem, and meropenem, with the drug resistance rate 16. 67%. Acinetobacter baurnannii strains were highly resistant to the commonly used antibiotics. Staphylococcus aureus and Staphylococcus epidermidis strains were highly resistant to peni

关 键 词：心脏外科术后 深部胸骨切口感染 临床特征 病原菌 耐药性 

分 类 号：R378[医药卫生—病原生物学]