Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Cardiovascular Surgery, Department of Surgery, E-DA Hospital and College of Medicine, I-Shou University, Kaohsiung, Taiwan.
Ann Thorac Surg. 2019 May;107(5):1333-1341. doi: 10.1016/j.athoracsur.2018.11.020. Epub 2018 Dec 12.
A bloodstream infection in patients undergoing cardiovascular operations is crucial because it can result in significantly worse outcomes. However, microbiological patterns have rarely been investigated in these patients.
We retrospectively reviewed the data of 1,041 adult patients who underwent cardiovascular operations using cardiopulmonary bypass from January 2013 to December 2017 at the National Cheng Kung University Hospital, Tainan, Taiwan. The microbiological pattern and associated variables were analyzed in patients with early postoperative primary bloodstream infection.
Primary bloodstream infection developed in 28 patients (2.7%) within 7 days after cardiovascular operations using cardiopulmonary bypass. In patients with early primary bloodstream infection, 36 microorganisms were isolated, and a gram-negative bacillus was identified to be the predominant pathogen (28 of 36 [77.8%]). The most common microorganisms comprised the Enterobacter (n = 8) and Acinetobacter (n = 7) species, and 16 of the 28 gram-negative bacilli belonged to the Enterobacteriaceae family. Compared with those without postoperative bloodstream infection, patients with Enterobacteriaceae family-related early postoperative bloodstream infections had a significantly longer cardiopulmonary bypass time and also worse early and late survival rates.
Most patients with early primary bloodstream infection after cardiovascular operations using cardiopulmonary bypass were infected with gram-negative bacilli, and the Enterobacteriaceae family was the most common microorganism observed. Endogenous bacterial translocation after prolonged cardiopulmonary bypass is a possible mechanism of Enterobacteriaceae family-related early primary bloodstream infection in these patients. Prophylactic use of an antibiotic regimen with broader gram-negative bacteria coverage in cardiovascular surgical patients with prolonged cardiopulmonary bypass should be considered.
心血管手术患者发生血流感染至关重要，因为这可能导致严重的预后不良。然而，此类患者的微生物学模式很少被研究。
我们回顾性分析了 2013 年 1 月至 2017 年 12 月在台湾国立成功大学医院接受体外循环心血管手术的 1041 例成年患者的数据。分析了手术后 7 天内发生早期原发性血流感染的患者的微生物学模式和相关变量。
28 例（2.7%）患者在体外循环心血管手术后 7 天内发生原发性血流感染。在早期原发性血流感染患者中，共分离出 36 种微生物，革兰氏阴性杆菌是主要病原体（28/36 [77.8%]）。最常见的微生物包括肠杆菌（n=8）和不动杆菌（n=7），28 株革兰氏阴性杆菌中有 16 株属于肠杆菌科。与未发生术后血流感染的患者相比，发生与肠杆菌科相关的术后早期血流感染的患者体外循环时间明显延长，且早期和晚期生存率更差。
体外循环心血管手术后早期原发性血流感染的大多数患者感染了革兰氏阴性杆菌，肠杆菌科是最常见的微生物。体外循环时间延长后内源性细菌易位可能是此类患者发生与肠杆菌科相关的早期原发性血流感染的机制。对于体外循环时间延长的心血管手术患者，应考虑使用覆盖范围更广的革兰氏阴性菌的抗生素方案进行预防。
