成人体外膜肺氧合术支持治疗患者医院感染流行病学特点  

Epidemiological characteristics of nosocomial infection in adult patients undergoing extracorporeal membrane oxygenation

作　　者：谈宜斌[1] 王莹[1] 蔡书翰[2] 夏剑[3] 彭志勇[2] 梁科[1] TAN Yi-bin;WANG Ying;CAI Shu-han;XIA Jian;PENG Zhi-yong;LANG Ke(Zhongnan Hospital,Wuhan University,Wuhan,Hubei 430071,China)

机构地区：[1]武汉大学中南医院医院感染管理办公室,湖北武汉430071 [2]武汉大学中南医院医院重症医学科,湖北武汉430071 [3]武汉大学中南医院医院急救中心,湖北武汉430071

出　　处：《中华医院感染学杂志》2020年第22期3434-3438,共5页Chinese Journal of Nosocomiology

基　　金：湖北省卫生健康委联合基金资助项目(WJ2019H044)。

摘　　要：目的分析成人体外膜肺氧合(ECMO)支持治疗患者医院感染流行病学特点。方法回顾性分析2017年7月01日-2019年6月30日武汉大学中南医院重症监护病房(ICU)31例应用ECMO支持治疗患者临床病例资料。所有患者根据是否发生医院感染分为感染组和非感染组。结果 31例患者中,发生医院感染9例,感染率29.03%。感染部位以肺部为主占53.57%,其次泌尿系统占17.86%。共检出病原菌21株,以革兰阴性菌(80.95%)为主,其中鲍氏不动杆菌占比最高为33.33%;革兰阳性菌(14.29%),以屎肠球菌(9.52%)为多。抗菌药物使用以碳青霉烯类占首位(21.59%),其中亚胺培南使用率中最高(20.14%)。单因素分析显示:患者ICU住院时间、体质量指数、ECMO支持时间为危险因素。结论 ECMO术后医院感染发生率较高,以肺部感染为主,病原菌以革兰阴性菌为主,碳青霉烯类是常用抗菌药物种类。OBJECTIVE To investigate the epidemiological characteristics of nosocomial infection in the adult patients undergoing extracorporeal membrane oxygenation(ECMO). METHODS The clinical data of 31 patients who were treated with ECMO in intensive care unit(ICU) of Zhongnan Hospital, Wuhan University from Jul 1, 2017 to Jun 30, 2019 were retrospectively analyzed, and the enrolled patients were divided into the infection group and the non-infection group according to the status of nosocomial infection. RESULTS Of the 31 patients, 9 had nosocomial infection, with the infection rate 29.03%. The patients with pulmonary infection accounted for 53.57%, the patients with urinary system infection 17.86%. A total of 21 strains of pathogens were isolated, 80.95% of which were gram-negative bacteria, and 14.29% were gram-positive bacteria;Acinetobacter baumannii was the predominant species of gram-negative bacteria, accounting for 33.33%;Enterococcus faecium was dominant among the gram-positive bacteria, accounting for 9.52%. Carbapenems(21.59%) were the most commonly used antibiotics, and the utilization rate of imipenem was the highest(20.14%). Univariate analysis indicated that the length of ICU stay, body mass index and time of ECMO supportive treatment were the high-risk factors. CONCLUSION The incidence of postoperative nosocomial infection is high among the ECMO patients, the patients with pulmonary infection were dominant, the gram-negative bacteria are the predominant pathogens, and carbapenems are the commonly used antibiotics.

关 键 词：体外膜肺氧合 医院感染 病原体 危险因素 流行病学研究 

分 类 号：R654.1[医药卫生—外科学]