2018-2022年某三甲医院心脏外科手术后医院感染特点及趋势  

Characteristics and trends of postoperative nosocomial infection in patients of cardiac surgery department of a three-A hospital from 2018 to 2022

作　　者：舒明蓉[1] 黄文治[1] 吴泓[1] SHU Ming-rong;HUANG Wen-zhi;WU Hong(West China Hospital of Sichuan University,Chendu,Sichuan 610041,China)

机构地区：[1]四川大学华西医院医院感染管理部,四川成都610041

出　　处：《中华医院感染学杂志》2023年第22期3439-3442,共4页Chinese Journal of Nosocomiology

基　　金：四川省软科学研究计划基金资助项目(2017ZR0170)。

摘　　要：目的研究心脏外科手术后医院感染特点及趋势,为制定防控措施提供依据.方法选取2018-2022年四川大学华西医院心脏外科进行手术的19392例患者为研究对象,前瞻性监测医院感染病例,分析医院心脏外科手术后医院感染部位、感染病原体及感染趋势.结果19392例心脏外科手术发生医院感染330例,348例次,感染率为1.70%,例次感染率为1.79%,5年手术后感染率呈上升趋势(P<0.001).术后感染部位主要是呼吸道、血液系统、泌尿道和手术部位;下呼吸道感染、术后肺炎、血液系统、泌尿道5年感染率呈上升趋势(P<0.05),手术部位5年感染率比较,无统计学差异.5年检出病原菌347株,以革兰阴性菌为主,主要为鲍氏不动杆菌和肺炎克雷伯菌,革兰阳性菌以金黄色葡萄球菌为主;其中耐药菌株共计48株,历年病原菌耐药菌株构成比逐年增加(P<0.05).结论心脏外科手术后医院感染发生率不高,但呈逐年上升趋势,应对相关危险因素采取有效地防控措施,尤其是手术后肺炎和血液感染防控;耐药菌构成比逐年增加,应加强抗菌药物合理使用.OBJECTIVE To investigate the characteristics and trends of postoperative nosocomial infection in patients of cardiac surgery department so as to provide bases for developing prevention measures.METHODS A total of 19392 patients who received surgical procedures in cardiac surgery department of West China Hospital of Sichuan University from 2018 to 2022 were recruited as the research subjects.The nosocomial infection cases were prospectively monitored,the sites of postoperative nosocomial infection,pathogens and trend of infection were analyzed.RESULTS Among the 19392 cardiac surgery departments who underwent surgical procedures,330(348 case-times)patients had nosocomial infection,with the infection rate 1.70%,the case-time infection rate 1.79%;the incidence of the postoperative infection showed an upward trend in the 5 years(P<0.001).The respiratory tract,blood system,urinary tract and surgical site were the major sites of postoperative infection.The incidence rates of lower respiratory tract infection postoperative pneumonia,blood system infection and urinary tract infection showed upward trends in the 5 years(P<0.05);there was no significant difference in the incidence of surgical site infection among the 5 years.Totally 347 strains of pathogens were isolated in the 5 years,the gram-negative bacteria were dominant among the pathogens,and Acinetobacter baumannii and Klebsiella pneumoniae were the predominant species;Staphylococcus aureus was the major species of gram-positive bacteria.Totally 48 strains of drug-resistant bacteria were isolated,and the constituent ratios of the drug-resistant strains were increased year by year(P<0.05).CONCLUSION The incidence of postoperative nosocomial infection is not high among the patients of cardiac surgery department but shows an upward trend.It is necessary to take effective prevention measures for the related risk factors and focus on the prevention and control of the postoperative pneumonia and blood infection.The constituent ratios of drug-resistant bacteria are increas

关 键 词：心脏手术 术后感染 感染监测 医院感染 病原菌 耐药率 趋势分析 

分 类 号：R654.2[医药卫生—外科学]