肝移植术后患者医院感染的流行病学特征
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摘要
目的分析肝移植患者术后医院感染的流行病学特征,为医院感染防控措施的制定提供依据。方法回顾性调查2015年1月-2017年12月广州市某三甲医院391例肝移植住院患者的临床资料,采用描述性研究的方法,对患者肝移植术后发生医院感染的情况进行统计分析。结果 391例肝移植患者中,48例发生术后医院感染,感染率为12.28%,平均感染例次1.42次;2015、2016、2017年的肝移植术后医院感染率分别为15.73%,11.76%和10.84%;不同性别、年龄患者的术后医院感染率差异无统计学意义;感染患者感染例次最多的部位是下呼吸道,35例占51.47%,其次是腹腔,14例占20.59%;感染患者共分离出77株病原菌体,其中,革兰阴性杆菌39株占50.65%,革兰阳性菌21株占27.27%,真菌17株占22.08%;致病菌以鲍氏不动杆菌,铜绿假单胞菌和屎肠球菌为主。结论在研究年限内,医院肝移植术后医院感染发生率逐年下降,围手术期感染综合防控工作的持续改进和新术式的开展对于降低肝移植术后感染率有着积极的作用。
OBJECTIVE To analyze the epidemiological characteristics of nosocomial infection after liver transplantation,so as to provide a basis for development of prevention measures.METHODS Medical records of 391 inpatients with liver transplantation in a hospital in Guangzhou from Jan.2015 to Dec.2017 were retrospectively investigated.The situation of nosocomial infection after liver transplantation was analyzed by descriptive study method.RESULTS Among the 391 patients,48 suffered from nosocomial infection(12.28%),1.42 times for each case.The infection rate after liver transplantation in our hospital was 15.73%,11.76% and 10.84%,respectively,in2015,2016 and 2017.There was no significant difference in postoperative nosocomial infection rate among patients with different gender and age(P>0.05).The most frequent infection sites were lower respiratory tract(35 cases,51.47%)and abdominal cavity(14 cases,20.59%).A total of 77 strains of pathogens were isolated from the infected patients,with 39 strains of gram-negative bacillus(50.65%),21 strains of gram-positive bacteria(27.27%)and 17 strains of fungi(22.08%).The most common pathogenic bacteria were Acinetobacter baumannii,Pseudomonas aeruginosa and Enterococcus faecium.CONCLUSION The nosocomial infection rate after liver transplantation was decreasing in the studied years.Improvement of comprehensive perioperative infection prevention and control as well as employment of new operation methods played a positive role in reducing the infection rate after liver transplantation.
OBJECTIVE To analyze the epidemiological characteristics of nosocomial infection after liver transplantation,so as to provide a basis for development of prevention measures.METHODS Medical records of 391 inpatients with liver transplantation in a hospital in Guangzhou from Jan.2015 to Dec.2017 were retrospectively investigated.The situation of nosocomial infection after liver transplantation was analyzed by descriptive study method.RESULTS Among the 391 patients,48 suffered from nosocomial infection(12.28%),1.42 times for each case.The infection rate after liver transplantation in our hospital was 15.73%,11.76% and 10.84%,respectively,in2015,2016 and 2017.There was no significant difference in postoperative nosocomial infection rate among patients with different gender and age(P>0.05).The most frequent infection sites were lower respiratory tract(35 cases,51.47%)and abdominal cavity(14 cases,20.59%).A total of 77 strains of pathogens were isolated from the infected patients,with 39 strains of gram-negative bacillus(50.65%),21 strains of gram-positive bacteria(27.27%)and 17 strains of fungi(22.08%).The most common pathogenic bacteria were Acinetobacter baumannii,Pseudomonas aeruginosa and Enterococcus faecium.CONCLUSION The nosocomial infection rate after liver transplantation was decreasing in the studied years.Improvement of comprehensive perioperative infection prevention and control as well as employment of new operation methods played a positive role in reducing the infection rate after liver transplantation.
引文
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[12]安玉玲,易小猛,魏绪霞,等.围手术期强化气道管理在预防肝移植术后肺部感染中的应用价值[J].中华肝脏外科手术学电子杂志,2015,4(3):169-172.
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[15]张红志,陈凡,高伟,等.成人活体肝移植术后早期感染情况及危险因素分析[J].实用器官移植电子杂志,2015,3(3):139-141.
[16]张毅,钟自彪,叶啟发,等.应用针对性抗生素防治公民逝世后器官捐献肝移植患者术后早期血流感染的疗效[J].武汉大学学报(医学版),2016,37(4):615-619.
[17] Raghuram A,Restrepo A,Safadjou S,et al.Invasive fungal infections following liver transplantation:incidence,risk factors,survival,and impact of fluconazole-resistant Candida parapsilosis(2003-2007)[J].Liver Transplant,2012,18:1100-1109.
[2]李晓杰,王庆亮,徐长志,等.肝移植患者术后肺部感染阿萨希丝孢酵母菌的临床与药物敏感性分析[J].中华医院感染学杂志,2016,26(7):1554-1556.
[3]林栋栋,刘晋宁.肝移植围术期感染的处理[J].北京医学.2017,39(9):895-896.
[4]朱欢,范琳琳,郑敏,等.肝移植患儿医院感染相关经济损失分析[J].中华医院感染学杂志,2017,27(24):5684-5687.
[5]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[6]臧晓青,钟林,彭志海.肝移植后感染的遗传易感性研究[J].中华临床医师杂志(电子版),2013,7(1):238-240.
[7]程艳爽,吕少诚,万涛,等.肝移植患者术后感染病原菌分布及耐药性分析[J].中华医院感染学杂志,2013,23(9):2221-2223.
[8]谭建辉,俞阿红,刘军,等.肝移植术后静脉导管相关感染原因分析及预防对策[J].中华医院感染学杂志,2014,24(4):956-958.
[9] Gao F,Ye QF,Wan QQ,et al.Distribution and resistance of pathogens in liver transplant recipients with Acinetobacter baumannii infection[J].Therap Clin Risk Manag 2015,11:501-505.
[10]杨富,陈兰,方芳,等.肝移植术后多重耐药菌感染危险因素的系统评价[J].上海交通大学学报(医学版),2015,35(7):1015-1022.
[11]徐广,郭海明,卜慧莲,等.肝移植术中肺保护性通气策略对术后肺部感染及肺功能、氧化应激的影响研究[J].中华医院感染学杂志,2016,26(22):5159-5162.
[12]安玉玲,易小猛,魏绪霞,等.围手术期强化气道管理在预防肝移植术后肺部感染中的应用价值[J].中华肝脏外科手术学电子杂志,2015,4(3):169-172.
[13] Bodro M,Sabe N,Tubau F,et al.Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients[J].Transplantation 2013,96:843-849.
[14]范明明,赵辉,傅斌生,等.肝移植术后早期肠内营养降低终末期肝病患者移植术后感染发生率的研究[J].中华普通外科学文献(电子版),2015,9(6):446-450.
[15]张红志,陈凡,高伟,等.成人活体肝移植术后早期感染情况及危险因素分析[J].实用器官移植电子杂志,2015,3(3):139-141.
[16]张毅,钟自彪,叶啟发,等.应用针对性抗生素防治公民逝世后器官捐献肝移植患者术后早期血流感染的疗效[J].武汉大学学报(医学版),2016,37(4):615-619.
[17] Raghuram A,Restrepo A,Safadjou S,et al.Invasive fungal infections following liver transplantation:incidence,risk factors,survival,and impact of fluconazole-resistant Candida parapsilosis(2003-2007)[J].Liver Transplant,2012,18:1100-1109.