小儿先天性心脏病手术后的医院感染：来自中国国家心血管病中心的数据。

Nosocomial Infections After Pediatric Congenital Heart Disease Surgery: Data from National Center for Cardiovascular Diseases in China.

作者信息

Wang Xiaofeng, Li Shuo, Huo Da, Zhu Zhiyuan, Wang Wenlong, He Hongxia, Zhang Qian, Li Jiantao, Wang Xu

机构信息

Department of Pediatric Intensive Care Unit, National Center for Cardiovascular Disease and Fuwai Hospital, Beijing, People's Republic of China.

School of Clinical Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.

出版信息

Infect Drug Resist. 2024 Apr 26;17:1615-1623. doi: 10.2147/IDR.S457991. eCollection 2024.

DOI:10.2147/IDR.S457991

PMID:38694890

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11061562/

Abstract

PURPOSE

Infection prevention and control (IPC) has a significant impact on the prognosis after pediatric cardiac surgery. This study aimed to provide surveillance data on the incidence and density of various infections during the COVID-19 epidemic and explore the influence of multi-drug resistant organisms (MDRO) on in-hospital prognosis after congenital heart disease surgery.

METHODS

This single-center retrospective study included pediatric patients who underwent cardiac surgery between 2021 and 2022. The results of the postoperative bacterial and fungal cultures and antimicrobial stewardship were collected. The demographic characteristics (age and weight), operation-related parameters (RACHS-1 grade, duration of cardiopulmonary bypass, and aortic cross clamp), and surgical outcomes (extracorporeal membrane oxygenation, delayed sternal closure, mortality, duration of mechanical ventilation, length of intensive care unit stay and hospital stay, and hospitalization costs) of MDRO and non-MDRO patients were compared.

RESULTS

A total of 4776 patients were included. There were 101 infectious culture results after the operation, with a nosocomial infection rate of 2.1%. There were 40 MDRO specimens from 36 patients, 50 non-MDRO specimens from 30 patients, and 11 fungal specimens from 10 patients. The incidence of pneumonia was 1.5%, with a ventilator-associated pneumonia incidence density of 7.2/1000 patient-days. The incidence of sepsis was 0.4%, with a catheter-related bloodstream infection incidence density of 0.24/ 1000 patient-days. The incidence density of catheter-associated tract infection was 0.45/ 1000 patient-days. The incidence of surgical site infection was 0.06%. The culture proportion before commencing antibiotics was 93% and the antibiotic consumption intensity was 30.7 DDD/100 bed-days. The length of intensive care unit stay in MDRO infection patients increased compared with that in non-MDRO infection patients, 30 (18,52) vs 17 (7,62) days, p=0.05).

CONCLUSION

The IPC performance of Fuwai Hospital achieved satisfactory results. MDRO infection can lead to prolonged intensive care unit stay.

摘要

目的

感染预防与控制（IPC）对小儿心脏手术后的预后有重大影响。本研究旨在提供新冠疫情期间各种感染的发病率和密度的监测数据，并探讨多重耐药菌（MDRO）对先天性心脏病手术后院内预后的影响。

方法

本单中心回顾性研究纳入了2021年至2022年间接受心脏手术的儿科患者。收集术后细菌和真菌培养结果以及抗菌药物管理情况。比较MDRO和非MDRO患者的人口统计学特征（年龄和体重）、手术相关参数（RACHS-1分级、体外循环时间和主动脉阻断时间）以及手术结局（体外膜肺氧合、延迟关胸、死亡率、机械通气时间、重症监护病房住院时间和住院时间以及住院费用）。

结果

共纳入4776例患者。术后有101份感染培养结果，医院感染率为2.1%。有来自36例患者的40份MDRO标本、来自30例患者的50份非MDRO标本以及来自10例患者的11份真菌标本。肺炎发病率为1.5%，呼吸机相关性肺炎发病密度为7.2/1000患者日。败血症发病率为0.4%，导管相关血流感染发病密度为0.24/1000患者日。导管相关通道感染发病密度为0.45/1000患者日。手术部位感染发病率为0.06%。开始使用抗生素前的培养比例为93%，抗生素消耗强度为30.7 DDD/100床日。MDRO感染患者的重症监护病房住院时间比非MDRO感染患者延长，分别为30（18,52）天和17（7,62）天，p = 0.05）。