体外膜氧合支持患者病原菌分布的回顾性研究  

Microbial profile in patients undergoing extracorporeal membrane oxygenation:a retrospective cohort study

作　　者：陈武 刘刚[1] 王靖[1] 王建[1] 王添隆 滕媛 吉冰洋[1] Chen Wu;Liu Gang;Wang Jing;Wang Jian;Wang Tianong;Teng Yuan;Ji Bingyang(Department of Cardiopulmonary Bypass,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院体外循环中心,北京100037 [2]遵义医科大学第二附属医院重症医学科,遵义563000

出　　处：《中国体外循环杂志》2025年第2期108-112,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的回顾分析体外膜氧合(ECMO)支持患者的病原菌分布情况。方法回顾中国医学科学院阜外医院体外生命支持电子数据库,收集2017年3月至2022年8月期间95例ECMO支持期间病原菌检出阳性的患者。收集患者临床资料、ECMO支持期间送检标本病原菌检出情况、感染指标峰值、ECMO运行情况及患者结局。结果患者平均年龄(51±14.4)岁,男性占62.10%;静脉-静脉ECMO3例,静脉-动脉ECMO92例;95例患者中89例患者痰标本检出阳性,15例尿标本阳性,3例血培养标本阳性。标本中检出G-杆菌阳性共86株,居前3位的分别是肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌;检出G+球菌阳性共82株,居前3位的分别是凝固酶阴性葡萄球菌、黄色葡萄球菌、肠球菌;检出真菌共64株,居前3位的分别是类酵母菌、丝状真菌、白假丝酵母菌。G-杆菌中鲍曼不动杆菌检出患者院内死亡率达76%,真菌中丝状真菌检出患者院内死亡率达60%,G+球菌中金黄色葡萄球菌检出患者院内死亡率达53.8%。结论ECMO支持期间患者痰标本阳性检出率较其它标本高;ECMO支持患者病情危重,免疫力低下,常合并多种病原菌感染。Objective To retrospectively analyze the microbial distribution patterns in patients receiving extracorporeal membrane oxygenation(ECMO).Methods This single-center retrospective cohort study analyzed 95 patients with microbiologically confirmed infections during ECMO support at Fuwai Hospital from March 2017 to August 2022.Clinical data,pathogen profiles from specimens,infection biomarkers,ECMO parameters,and mortality outcomes were systematically evaluated.Results The cohort(mean age 51±14.4 years,62.1%male)predominantly received venoarterial ECMO(V-A ECMO:92/95).Respiratory specimens demonstrated the highest positivity rate(89/95,93.7%),followed by urinary(15/95,15.8%)and bloodstream infections(3/95,3.2%).Gram-negative bacilli(86 isolates)predominated,with Klebsiella pneumoniae(26.7%),Pseudomonas aeruginosa(22.1%),and multidrug-resistant Acinetobacter baumannii(18.6%)as leading pathogens.Gram-positive cocci(82 isolates)were primarily coagulase-negative staphylococci(34.1%),Staphylococcus aureus(29.3%),and Enterococcus spp.(19.5%).Fungal infections(64 isolates)featured Candida species(56.3%),filamentous fungi(23.4%),and Candida albicans(20.3%).Notably,A.baumannii infections correlated with 76%in-hospital mortality,filamentous fungi with 60%,and S.aureus with 53.8%.Conclusion During ECMO support,patients exhibit a significantly higher positivity rate in sputum specimens compared to other sample types.Patients receiving ECMO are critically ill with compromised immune function,frequently presenting with polymicrobial co-infections.

关 键 词：体外膜氧合 静脉-动脉体外膜氧合 病原菌 院内感染 

分 类 号：R446.5[医药卫生—诊断学]