181例心脏外科患者发生血流感染危险因素分析  

Risk factors of patients with bloodstream infection in cardiac surgery

作　　者：武元星[1] 任建伟 朱光发[1] Wu Yuanxing;Ren Jianwei;Zhu Guangfa(Department of Respiratory 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：《中华实验和临床感染病杂志（电子版）》2023年第4期230-237,共8页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：国家自然科学基金(No.81970067)。

摘　　要：目的探讨心脏外科患者发生血流感染的危险因素,观察多菌种血流感染与单一阴性菌血流感染的临床特征,为预防心脏外科患者血流感染发生和治疗提供依据。方法选取2018年1月至2021年10月首都医科大学附属北京安贞医院心脏外科收治的血流感染者资料,总结病原体检出及分布;选取同时期心脏外科非感染者,与感染组患者根据年龄、性别进行1︰1配比,分析血流感染组(包括革兰阴性菌和阳性菌的混合感染与单一阴性菌感染)与非血流感染组患者临床资料,计量资料比较采用t检验或非参数检验,计数资料比较采用χ^(2)检验,将可能影响血流感染的指标进行多因素Logistic回归,分析血流感染及混合血流感染发生的危险因素。结果同时期共收治心脏外科患者55908例,发生血流感染者181例,感染率为0.3%(181/55908)。血流感染组与非血流感染组间体外循环(CPB)时间(Z=5.031、P=0.001)和手术时间(Z=3.830、P=0.001)、是否接受体外膜肺氧合(ECMO)(χ^(2)=11.569、P=0.001)、主动脉内球囊反搏术(IABP)(χ^(2)=30.685、P=0.001)和连续性肾脏替代治疗(CRRT)(χ^(2)=24.761、P=0.001)支持、感染发生前使用碳青霉烯类(χ^(2)=11.661、P=0.001)、喹诺酮类(χ^(2)=4.096、P=0.043)、万古霉素(χ^(2)=4.096、P=0.043)以及联合使用抗菌药物(χ^(2)=13.286、P=0.001)差异均有统计学意义;多因素Logistic回归分析发现,CPB时间(OR=5.031、95%CI:1.843~6.798、P<0.001)和手术时间(OR=1.228、95%CI:1.056~1.427、P=0.008)、接受ECMO(OR=4.180、95%CI:1.863~9.377、P=0.001)、IABP(OR=4.017、95%CI:1.572~10.267、P=0.004)和CRRT(OR=8.586,95%CI:2.494~29.560、P=0.001)操作、血流感染发生前使用碳青霉烯类(OR=15.742、95%CI:5.699~43.478、P<0.001)、喹诺酮类(OR=2.272、95%CI:1.057~4.886、P=0.030)、万古霉素(OR=4.297,95%CI:1.199~15.400、P=0.025)以及联合使用抗菌药物(OR=4.520、95%CI:2.154~9.484、P=0.001)均为术后血流感染发生的危险�Objective To investigate the risk factors of the occurrence of bloodstream infection,and to analyze the difference of clinical characteristics between multi-bacterial bloodstream infection and single negative bacteria,to provide evidence for the prevention and treatment of bloodstream infection in cardiac surgery.Methods Medical records of patients with bloodstream infection in Department of Cardiac surgery,Beijing Anzhen Hospital,Capital Medical University from January 2018 to October 2021 were selected to summarize the detection and distribution of pathogens.Non-infection patients were selected with 1︰1 according to the age and gender of patients in infection group during the same period.The clinical data of the bloodstream infection group(including the multi-bacterial infection and single infection of Gram-negative bacteria and Gram-positive bacteria)and the non-infection group were analyzed,respectively.The measurement data were analyzed by t test or non-parametric test,and the counting data was analyzed byχ^(2) test.The indicators that may affect bloodstream infection were analyzed by multivariate Logistic regression,the risk factors of bloodstream infection and mixed bloodstream infection were analyzed.Results During the same period,a total of 55908 cardiac surgery patients were admitted,and 181 cases with bloodstream infection,with an infection rate of 0.3%(181/55908).The results showed that CPB time(Z=5.031,P=0.001)and operation time(Z=3.830,P=0.001),usage of ECMO(χ^(2)=11.569,P=0.001),IABP(χ^(2)=30.685,P=0.001)and CRRT(χ^(2)=24.761,P=0.001),exposure to carbapenems(χ^(2)=11.661,P=0.001),quinolones(χ^(2)=4.096,P=0.043),vancomycin(χ^(2)=4.096,P=0.043)and combined antibiotics(χ^(2)=13.286,P=0.001)before infection were statistically different between infection group and non-infection group.Multivariate Logistic regression analysis showed that CPB time(OR=5.031,95%CI:1.843-6.798,P<0.001)and operation time(OR=1.228,95%CI:1.056-1.427,P=0.008),usage of ECMO(OR=4.180,95%CI:1.863-9.377,P=0.001),IABP(OR=4.

关 键 词：血流感染 血管内装置植入 病原学 危险因素 预后 

分 类 号：R446.5[医药卫生—诊断学]