某院心脏手术患者导管相关感染病原菌及危险因素  

Pathogens causing catheter-related infections in cardiac surgery patients and risk factors

作　　者：周云英[1] 刘华芬[2] 谢爱民[3] 陶宇[3] ZHOU Yun-ying;LIU Hua-fen;XIE Ai-min;TAO Yu(Jiangxi Provincial People's Hospital,Nanchang,Jiangxi 330006,China;不详)

机构地区：[1]江西省人民医院心内科,江西南昌330006 [2]武汉大学人民医院心内科,湖北武汉430000 [3]江西省人民医院心脏科,江西南昌330006

出　　处：《中华医院感染学杂志》2020年第21期3312-3315,共4页Chinese Journal of Nosocomiology

基　　金：江西省自然科学基金资助项目(2019742)。

摘　　要：目的分析心脏手术患者中心静脉导管(CVC)血管内导管相关感染病原菌及危险因素。方法回顾性分析2017年1月-2019年11月在江西省人民医院心内科接受心脏手术治疗的208例患者,根据术后是否发生CVC血管内导管相关感染,分为感染组37例和未感染组171例。无菌采集血液标本和CVC导管尖端标本进行病原菌鉴定及药敏试验,统计患者年龄、是否存在糖尿病、置管时间等临床特征,采用二分类Logistic回归分析影响感染的危险因素。结果37例样本中共分离出41株病原菌,病原菌以金黄色葡萄球菌(26.83%)、鲍氏不动杆菌(19.51%)和表皮葡萄球菌(17.07%)为主;金黄色葡萄球菌对青霉素G、哌拉西林、头孢哌酮等耐药率较高,对万古霉素敏感;鲍氏不动杆菌对哌拉西林、阿米卡星、头孢唑林、庆大霉素等耐药率较高,对亚胺培南敏感;年龄(OR=1.866,P=0.030)、合并糖尿病(OR=1.984,P=0.014)、置管时间(OR=2.063,P=0.007)均为影响感染的危险因素。结论心脏手术患者CVC血管内导管相关感染病原菌以葡萄球菌属为主,临床可优先选择相对敏感的万古霉素、亚胺培南等药物治疗,重点关注高龄、合并糖尿病和置管时间>7 d的患者。OBJECTIVE To investigate the pathogens causing central venous catheter(CVC)-related infections in cardiac surgery patients and analyze the risk factors.METHODS A total of 208 patients who received cardiac surgery in department of cardiology of Jiangxi Provincial People’s Hospital from Jan 2017 to Nov 2019 were retrospectively analyzed,the enrolled patients were divided into the infection group with 37 cases and the non-infection group with 171 cases according to the status of CVC-related infection.The blood specimens and CVC tip samples were collected,the isolated pathogens were identified,the drug susceptibility testing was performed,the clinical characteristics such as age,diabetes mellitus and catheter indwelling time were statistically analyzed,and the binary logistic regression analysis was performed for the influencing factors for the infections.RESULTS Totally 41 strains of pathogens were isolated from 37 samples,26.83%of which were Staphylococcus aureus,19.51%were Acinetobacter baumannii,and 17.07%were Staphylococcus epidermidis.The S.aureus strains were highly resistant to penicillin G,piperacillin and cefoperazone,and the strains were sensitive to vancomycin.The A.baumannii strains were highly resistant to piperacillin,amikacin,cefazolin and gentamicin,and the strains were sensitive to imipenem.The age(OR=1.866,P=0.030),complication with diabetes mellitus(OR=1.984,P=0.014)and catheter indwelling time(OR=2.063,P=0.007)were the risk factors for the infections.CONCLUSION Staphylococcus spp is dominant among the pathogens causing CVC-related infections in the cardiac surgery patients.It is necessary for the hospital to choose vancomycin and imipenem for treatment and focus on the patients with advanced age,complication of diabetes mellitus and catheter indwelling time more than 7 days.

关 键 词：心脏手术 中心静脉导管 感染 病原菌 

分 类 号：R619.3[医药卫生—外科学]