心脏外科瓣膜术后耐碳青霉烯类革兰阴性杆菌感染临床特征与影响因素  

Clinical characteristics and influencing factors of carbapenem-resistant Gram-negative bacilli infection after cardiac valve surgery

作　　者：武元星[1] 任建伟 朱光发[1] WU Yuan-xing;REN Jian-wei;ZHU Guang-fa(Department of Pulmonary and Critical Care Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院呼吸与危重症医学科,北京100029

出　　处：《中国感染控制杂志》2023年第8期886-893,共8页Chinese Journal of Infection Control

基　　金：国家自然科学基金资助项目(81970067)。

摘　　要：目的了解心脏瓣膜术后医院感染及耐碳青霉烯类革兰阴性菌(CR-GNB)感染的临床特征、耐药性及影响因素。方法回顾性收集2018年1月—2021年10月某院心脏瓣膜术后患者的临床资料,按术后是否发生CR-GNB感染分为CR-GNB组和非耐碳青霉烯类革兰阴性菌(non-CR-GNB)组,选取同时期非感染患者,按年龄、性别与不同感染组(CR-GNB组和non-CR-GNB组)分别进行2∶1配对,分析感染发生的影响因素,比较各组患者临床特征的差异。结果11120例瓣膜手术患者,术后296例(2.7%)发生医院感染,其中170例为革兰阴性菌感染,126例为革兰阳性菌感染。革兰阴性菌感染患者中,62(36.5%)例归为CR-GNB组,108例(63.5%)为non-CR-GNB组。CR-GNB组患者检出112株CR-GNB,以鲍曼不动杆菌最多(48株,42.9%),对多种常用抗菌药物耐药率较高,仅对阿米卡星和多黏菌素耐药率较低(分别为12.5%、5.3%)。各组比较,CR-GNB组较non-CR-GNB组患者、CR-GNB组较非感染组患者、non-CR-GNB较非感染组患者手术时间、ICU停留时间和体外循环时间更长,感染前使用抗菌药物的比例更高(均P<0.05)。多因素分析结果显示,手术时间、ICU停留时间和体外循环时间是心脏外科瓣膜术后患者CR-GNB感染的独立危险因素(均P<0.05)。CR-GNB组和non-CR-GNB组患者全因病死率(31.8%,54/170)高于非感染组患者(5.0%,17/340;P<0.05)。结论加强心脏外科手术治疗期间围手术期管理至关重要,优化手术操作及合理使用抗菌药物可减少耐药菌的发生,改善患者预后。Objective To understand the clinical characteristics,antimicrobial resistance and influencing factors of healthcare-associated infection(HAI)as well as carbapenem-resistant Gram-negative bacterial(CR-GNB)infection after cardiac valve surgery.Methods Clinical data of patients after cardiac valve surgery in a hospital from January 2018 to October 2021 were collected retrospectively and divided into the CR-GNB group and the non-CR-GNB group according to whether CR-GNB infection had occurred after surgery,non-infected patients in the same period were selected,and paired in a 2∶1 ratio with different infection groups(CR-GNB group and non-CR-GNB group)based on age and gender,the influencing factors for infection were analyzed,and the differences in clinical characteristics among groups were compared.Results Among the 11120 patients underwent cardiac valve surgery,296 cases(2.7%)developed HAI,including 170 cases of Gram-negative bacterial infection and 126 cases of Gram-positive bacterial infection.Among patients with Gram-negative bacterial infection,62 cases(36.5%)were in the CR-GNB group,and 108 cases(63.5%)in the non-CR-GNB group.112 CR-GNB strains were isolated from patients in the CR-GNB group,most of which were Acinetobacter baumannii(n=48,42.9%),showing high resistance rates to several commonly used antimicrobial agents,except amikacin(12.5%)and polymyxin(5.3%).Comparing among groups,the durations of surgery,ICU stay,and extracorporeal circulation were longer in the CR-GNB group than in the non-CR-GNB group and in the non-infected group,and the non-CR-GNB group than the non-infected group.The proportion of antimicrobial use before infection was higher(all P<0.05).Multivariate analysis showed that durations of operation,ICU stay and extracorporeal circulation were independent risk factors for CR-GNB infection in patients after cardiac valve surgery(all P<0.05).The all-cause fatalities of patients in the CR-GNB and non-CR-GNB groups(31.8%,54/170)were higher than that in the non-infected group(5.0%,17/340;P<0.05)

关 键 词：心脏瓣膜术后 碳青霉烯类 革兰阴性菌 耐药性 影响因素 

分 类 号：R181.32[医药卫生—流行病学] R654.2[医药卫生—公共卫生与预防医学]