心血管手术患者术前鼻腔定植菌分布及病原学研究  

Distribution and etiology of nasal colonizing bacteria in patients before undergoing cardiovascular surgery

作　　者：王晓苏 丛蓉 张李涛 WANG Xiaosu;CONG Rong;ZHANG Litao(Department of Clinical Laboratory,Wuhan Asian Heart General Hospital,Wuhan,Hubei 430000,China;Department of Clinical Laboratory,Wuhan Asia Heart Hospital,Wuhan,Hubei 430000,China)

机构地区：[1]武汉亚心总医院检验科,湖北武汉430000 [2]武汉亚洲心脏病医院检验科,湖北武汉430000

出　　处：《检验医学与临床》2023年第20期2982-2985,共4页Laboratory Medicine and Clinic

摘　　要：目的了解心血管手术患者术前鼻腔定植菌的分布及病原菌耐药情况。方法对拟择期行心血管手术的患者进行术前鼻腔定植菌筛查,并对检出的病原菌进行药敏试验。结果共采集2016年1月至2018年12月拟择期行心血管手术的住院患者鼻腔标本8592份,分离出病原菌576株,分离率为6.70%。576株病原菌中革兰阴性菌386株(67.01%),以肺炎克雷伯菌、卡他莫拉菌、大肠埃希菌为主;革兰阳性菌190株(32.99%),以金黄色葡萄球菌和肺炎链球菌为主。576株病原菌中,男、女构成比比较,差异无统计学意义(P>0.05);≥15岁患者和<15岁患者构成比比较,差异有统计学意义(P<0.05)。共分离出74株多重耐药菌,其中耐甲氧西林金黄色葡萄球菌(MRSA)66株(89.19%),耐碳青霉烯类革兰阴性菌8株(10.81%)。结论<15岁心血管手术患者术前鼻腔MRSA等病原菌携带率较高,应引起重视;术前早期筛查MRSA并去定植,能降低术后MRSA感染率;阴性筛查结果有助于排除术后MRSA感染。Objective To investigate the distribution of nasal bacterial colonization and drug resistance of pathogenic bacteria in patients before undergoing cardiovascular surgery.Methods The patients before undergoing elective cardiovascular surgery were screened for nasal colonizing bacteria,and the drug sensitivity test was performed for the pathogens detected.Results From January 2016 to December 2018,a total of 8592 nasal cavity specimens were collected from hospitalized patients who were scheduled to undergo elective surgery for new trainees,and 576 strains of pathogenic bacteria were isolated,with an isolation rate of 6.70%.Among the 576 strains of pathogenic bacteria,386 strains(67.01%)were Gram-negative bacteria,mainly Klebsiella pneumoniae,Moraxella catarrhalis and Escherichia coli.There were 190(32.99%)strains of gram-positive bacteria,mainly Staphylococcus aureus and Streptococcus pneumoniae.Among the 579 strains of pathogenic bacteria,there was no statistically significant difference in the constituent ratio of male and female(P>0.05).There was a statistically significant difference in the constituent ratio of patients≥15 years old and patients<15 years old(P<0.05).A total of 74 strains of multi-drug resistant bacteria were isolated,including 66 strains(89.19%)of methicillin-resistant Staphylococcus aureus(MRSA)and 8 strains(10.81%)of carbapenem-resistant gram-negative bacteria.Conclusion The carrier rate of MRSA and other pathogenic bacteria in nasal cavity of patients under 15 years old before undergoing cardiovascular surgery is high,which should be paid attention to.Early preoperative screening and decolonization of MRSA can reduce the postoperative MRSA infection rate.A negative screening test can help rule out postoperative MRSA infection.

关 键 词：感染性心内膜炎 药敏试验 耐甲氧西林金黄色葡萄球菌 

分 类 号：R378.1[医药卫生—病原生物学] R446.5[医药卫生—基础医学]