先天性心脏病患儿术后并发医院感染的危险因素及其病原菌分布和药敏实验分析

目的:统计先天性心脏病(CHD)患儿术后医院感染的病原菌分布及细菌耐药性情况,分析影响CHD患儿术后医院感染的危险因素。方法:回顾性选取2010年3月-2017年10月我院行CHD手术治疗的患儿3800例,收集临床标本进行致病菌培养并进行药敏试验,统计CHD术后医院感染患儿病原菌种类及主要致病菌的耐药情况,分析影响CHD患儿术后医院感染的危险因素。结果:3800例CHD患儿术后医院感染率为3.13%(119/3800),共分离出菌株172株,G^-菌、G⁺菌、真菌分别占55.81%(96/172)、26.74%(46/172)、17.44%(30/172)。肺炎克伯雷菌、大肠杆菌对头孢类抗生素高度耐药,鲍曼不动杆菌检出率逐年增高,且仅对多黏菌素B保持敏感;肺炎链球菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌对大环内脂类抗生素、克林霉素、青霉素高度耐药,对万古霉素和替加环素保持敏感。术后医院感染与年龄、体重、病程、手术时间、体外循环时间、机械通气时间、ICU停留时间、住院时间、合并肺动脉高压、吸痰次数、静脉营养、应用丙种球蛋白或白蛋白有关(P<0.05),且合并肺动脉高压、体外循环时间≥100 min、机械通气时间≥120 h、吸痰次数≥5次/d是CHD患儿术后医院感染的危险因素(P<0.05)。结论:G^-菌、G⁺菌是CHD患儿术后医院感染的主要致病菌,且对常用抗生素高度耐药,此外鲍曼不动杆菌的检出率和耐药性上升极为明显,合并肺动脉高压、体外循环时间及机械通气时间过长、吸痰次数多的CHD患儿医院感染风险升高。

Risk Factors of Postoperative Nosocomial Infection in Children with Congenital Heart Disease and Their Pathogenic Bacteria Distribution and Drug Sensitivity Analysis

ABSTRACT Objective: To investigate the distribution of pathogens and bacterial resistance of postoperative nosocomial infection in children with congenital heart disease (CHD), and analyze the risk factors of postoperative nosocomial infection in children with CHD. Methods: 3800 cases of CHD children after surgical treatment in our hospital from March 2010 to October 2017 were selected retrospectively. Clinical specimens were collected for pathogen culture and drug sensitivity test, the types of pathogens and the drug resistance of main pathogens were analyzed, the risk factors of postoperative nosocomial infection in children with CHD were analyzed. Results: The hospital infection rate of 3800 children with CHD was 3.13% (119/3800), A total of 172 strains were isolated, G^- strain, G⁺ strain and fungi accounted for 55.81% (96/172), 26.74% (46/172) and 17.44% (30/172) respectively. Klebsiella pneumoniae and Escherichia coli have high resistance rate to cephalosporins, the detection rate of Acinetobacter baumannii is increasing year by year, and it was sensitive to polymyxin B only; Streptococcus pneumoniae, coagulase negative Staphylococcus and Staphylococcus aureus are highly resistant to lipid antibiotics, clindamycin and penicillin, and sensitive to vancomycin and tegacyclin. The postoperative hospital infection were related to age, weight, course of disease, time of operation, time of cardiopulmonary bypass, mechanical ventilation time, ICU stay time, length of stay, whether pulmonary hypertension, phlegm times, intravenous nutrition, use of gamma globulin or white protein (P<0.05), and pulmonary hypertension, cardiopulmonary bypass time greater than or equal to 100 min, mechanical ventilation time greater than or equal to 120 h, sputum number greater than or equal to 5 times/d were risk factors for postoperative hospital infection in children with CHD (P<0.05). Conclusion: G^- strain, G⁺ strain are the main pathogenic bacteria of postoperative hospital infection in children with CHD, and highly resistant to common antibiotics, in addition, the detection rate and drug resistance of Acinetobacter baumannii increased significantly, the risk of infection in children with pulmonary hypertension, cardiopulmonary bypass and mechanical ventilation time too long, too many sputum number is increased.