Qilu Hospital Affiliated to Shandong University, Jinan, Shandong, China.
Medicine (Baltimore). 2021 Jan 29;100(4):e24162. doi: 10.1097/MD.0000000000024162.
Nosocomial infections (NI) are common complications after cardiac surgery. To date, there have been few manuscripts investigating NI in the intensive care unit after cardiac surgery. Our study was designed to investigate the characteristics of the distribution of pathogenic bacteria, antibiotic resistance and risk factors for NI.A total of 1360 patients received standard postoperative care, including antibiotic prophylaxis. Microbiological examinations of sputum, blood, catheter tips and excrement were performed as clinically indicated to isolate pathogens. Thirty potential associated variables were collected and compared between the 2 different groups according to the development of NI using univariate and multivariate analyses.Eighty-nine patients (6.54%) acquired a microbiologically documented NI. There was a significant difference in mortality between the 2 groups with or without postoperative NI (23.60% vs 2.28%, P < .00). A total of 98 pathogens (73.13%) were isolated from sputum, 32 pathogens (23.88%) from blood and only 1 (0.75%) from urine. Three (2.24%) surgical site infections were detected, including 2 superficial surgical site infections and 1 mediastinitis. The most common pathogens were Gram-negative bacteria (78.36%), followed by Gram-positive bacteria (14.93%) and fungi (6.71%). The major pathogenic species had different levels of drug resistance, and most of them exhibited multidrug resistance. Six out of thirty variables were identified as independent risk factors for the development of NI, namely, duration of surgery, low cardiac output syndrome, continuous veno-venous hemofiltration, mechanical ventilation time, reintubation and tracheostomy.We analyzed the characteristics of the distribution of pathogens, antibiotic resistance and risk factors for NI in our center and provided some suggestions for clinical practice. In addition to antibiotic treatment, avoidance of risk factors and aggressive infection control measures may be crucial to stop or prevent outbreaks.
医院获得性感染（NI）是心脏手术后常见的并发症。迄今为止，很少有文献研究心脏手术后重症监护病房中的 NI。我们的研究旨在调查病原菌分布、抗生素耐药性和 NI 危险因素的特点。
共有 1360 例患者接受了标准的术后护理，包括抗生素预防。根据是否发生 NI，对痰液、血液、导管尖端和粪便进行微生物检查，以分离病原体。收集了 30 个潜在的相关变量，并通过单变量和多变量分析比较了两组之间的差异。
89 例（6.54%）患者获得了微生物学确诊的 NI。有术后 NI 与无术后 NI 两组之间的死亡率有显著差异（23.60% vs 2.28%，P<0.00）。从痰液中分离出 98 种病原体（73.13%），从血液中分离出 32 种病原体（23.88%），仅从尿液中分离出 1 种（0.75%）。检测到 3 例（2.24%）手术部位感染，包括 2 例浅表手术部位感染和 1 例纵隔炎。最常见的病原体是革兰氏阴性菌（78.36%），其次是革兰氏阳性菌（14.93%）和真菌（6.71%）。主要的致病菌种有不同程度的耐药性，且多数表现为多重耐药。30 个变量中有 6 个被确定为 NI 发生的独立危险因素，即手术时间、低心输出量综合征、连续静脉-静脉血液滤过、机械通气时间、重新插管和气管切开。
我们分析了中心内 NI 的病原菌分布、抗生素耐药性和危险因素的特点，并为临床实践提供了一些建议。除了抗生素治疗外，避免危险因素和积极的感染控制措施对于阻止或预防暴发可能至关重要。
