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[心脏手术后手术部位感染的监测——自身经验]

[Surgical site infections following cardiac surgery supervision--own experience].

作者信息

Wójkowska-Mach Jadwiga, Baran Magda, Synowiec Edyta, Foryciarz Ewelina, Bigosiński Jerzy, Sadowski Jerzy, Bulanda Małgorzata, Heczko Piotr B

机构信息

Katedra Mikrobiologii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie.

出版信息

Przegl Lek. 2008;65(7-8):335-9.

PMID:19004231
Abstract

In spite of advances of knowledge in the area of controlling hospital infections SSI remains main cause of morbidity and mortality among patients undergoing surgical treatment. In the current paper, results of epidemiological and microbiological analyses of SSI are summarized, regarding patients, subject to surgical treatments in cardiovascular surgery and transplantation unit. In 2002-2004, 7980 surgical treatments were carried out--identified 130 SSIs. Infections were classified, according to definitions and criteria of the NNIS. Medication sensitivity of the bacteria regarded to be a SSI etiological factor was tested using the circular diffusion method, according to specifications of the NCCLS. A SSI morbidity of 3.0-3.2% was found, mortality: 9.8%. The rate of cardiovascular surgery-related SSIs--comparing favorably with CDC national data. Post-discharge recording covered 25% of cases, including patients who required repeated hospitalization. Among etiological factors of all the clinical forms of the SSI, a dominant part was consisted of gram-positive positive cocci (65.4%). Each of the identified SSIs was subject to microbiological diagnosing, in order to identify etiological factors. Prevalence of G(+) bacteria was found among isolated bacterial flora, although numerous occurrences of G(-) cocci were also identified. The obtained data confirm the necessity of continued close cooperation of the Infection Control Team with the microbiological laboratory. The analysis of data pertaining to leading SSI etiological factors as well as their medication susceptibility should enable elaboration of own standards for surgical infection prophylaxis and empirical therapy to be used in the ward being a subject of study.

摘要

尽管在控制医院感染领域知识有所进步,但手术部位感染(SSI)仍是接受外科治疗患者发病和死亡的主要原因。在本文中,总结了心血管外科和移植科接受手术治疗患者的SSI流行病学和微生物学分析结果。2002 - 2004年,共进行了7980例外科手术,确定了130例SSI。根据美国国家医院感染监测系统(NNIS)的定义和标准对感染进行分类。按照美国国家临床实验室标准委员会(NCCLS)的规范,使用纸片扩散法检测被视为SSI病因的细菌的药物敏感性。发现SSI发病率为3.0 - 3.2%,死亡率为9.8%。与美国疾病控制与预防中心(CDC)的全国数据相比,心血管外科相关SSI的发生率良好。出院后记录涵盖了25%的病例,包括需要再次住院的患者。在所有临床形式的SSI病因中,革兰氏阳性球菌占主导部分(65.4%)。对每例确诊的SSI进行微生物诊断,以确定病因。在分离出的细菌菌群中发现革兰氏阳性(G(+))菌占优势,尽管也发现了大量革兰氏阴性(G(-))球菌。所获数据证实了感染控制团队与微生物实验室持续密切合作的必要性。对与主要SSI病因及其药物敏感性相关的数据进行分析,应有助于制定在作为研究对象的病房中使用的外科感染预防和经验性治疗的自身标准。

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