抗菌药物预防心肌梗死患者介入治疗后医院感染的效果研究
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摘要
目的 研究抗菌药物预防心肌梗死患者介入治疗后医院感染的效果。方法 选取2015年12月-2017年11月医院急性心肌梗死介入治疗术患者336例为研究对象,根据术前、术后使用抗菌药物的情况,随机按照1∶1∶1∶1比例将其分为Ⅰ组、Ⅱ组、Ⅲ组和Ⅳ组,各84例。Ⅰ组患者,术前预防性使用抗菌药物0.5 h、术后抗菌药物预防使用72 h以上;Ⅱ组患者,术前预防性使用抗菌药物0.5 h、术后抗菌药物预防使用72 h;Ⅲ组患者仅术前预防性使用抗菌药物0.5 h;Ⅳ组患者,介入前后均未采用任何抗菌药物预防医院感染。比较四组患者心肌梗死介入治疗后白细胞计数、中性粒细胞百分比及介入术后医院感染情况。结果 医院感染率Ⅰ、Ⅱ、Ⅲ组低于Ⅳ组(P<0.05);多药耐药率Ⅰ组高于Ⅱ、Ⅲ、Ⅳ组(P<0.05);白细胞计数异常率、中性粒细胞百分比异常率Ⅰ、Ⅱ、Ⅲ组低于Ⅳ组(P<0.05);四组患者心肌梗死介入治疗后呼吸道感染构成比均高于同组泌尿道感染、介入部位感染和血行感染构成比(P<0.05);住院时间Ⅰ、Ⅱ、Ⅲ组短于Ⅳ组(P<0.05);成本-效果比Ⅰ、Ⅱ、Ⅲ组小于Ⅳ组,Ⅲ组小于Ⅰ、Ⅱ组(P<0.05)。结论 术前预防使用抗菌药物0.5 h能有效降低心肌梗死介入术后医院感染率,但过度使用可使耐药率升高、增加经济负担。
OBJECTⅣE To study the effect of antimicrobial agents on prevention of nosocomial infection after interventional therapy of myocardial infarction. METHODS A total of 336 patients with acute myocardial infarction who received interventional therapy in the hospital from Dec. 2015 to Nov. 2017 were enrolled. According to the preoperative and postoperative antimicrobial usage, they were divided into groups Ⅰ, Ⅱ, Ⅲ and Ⅳ(84 cases each) using the random number table method with the ratio of 1∶1∶1∶1. The group Ⅰ was treated with preventive use of antibiotics for 0.5 h before the surgery and for more than 72 hours after the surgery; the group Ⅱ was treated with preventive use of antibiotics for 0.5 h before the surgery and for 72 hours after the surgery; the group Ⅲ was only treated with preventive use of antibiotics for 0.5 h before the surgery; the group Ⅳ was not treated with any antibiotics for prevention of nosocomial infection before and after the surgery. The white blood cell count, the percentage of neutrophils and the nosocoial infection rate after interventional therapy were compared among the four groups. RESULTS The nosocomial infection rate in group Ⅰ, Ⅱ and Ⅲ was significantly lower than that in group Ⅳ(P<0.05); the multidrug resistance rate in group Ⅰ was significantly higher than that in group Ⅱ, Ⅲ and Ⅳ(P<0.05); the abnormal rate of white blood cell count and percentage of neutrophils in group Ⅰ, Ⅱ and Ⅲ were significantly lower than those in group Ⅳ(P<0.05); the proportion of respiratory tract infection in the four groups was significantly higher than those of infections at the urinary tract, intervening site and blood stream in the same group after interventional therapy(P<0.05); hospitalization time in group Ⅰ, Ⅱ and Ⅲ was significantly shorter than that in group Ⅳ(P<0.05); cost-effectiveness in group Ⅰ, Ⅱ and Ⅲ was significantly lower than that in group Ⅳ, and that in group Ⅲ was less than that in group Ⅰ and Ⅱ(P<0.05). CONCLUSⅠON Preoperative preventive use of antibiotics for 0.5 h can effectively reduce the nosocomial infection rate after myocardial infarction intervention, but overuse can increase the drug resistance rate and increase the economic burden.
OBJECTⅣE To study the effect of antimicrobial agents on prevention of nosocomial infection after interventional therapy of myocardial infarction. METHODS A total of 336 patients with acute myocardial infarction who received interventional therapy in the hospital from Dec. 2015 to Nov. 2017 were enrolled. According to the preoperative and postoperative antimicrobial usage, they were divided into groups Ⅰ, Ⅱ, Ⅲ and Ⅳ(84 cases each) using the random number table method with the ratio of 1∶1∶1∶1. The group Ⅰ was treated with preventive use of antibiotics for 0.5 h before the surgery and for more than 72 hours after the surgery; the group Ⅱ was treated with preventive use of antibiotics for 0.5 h before the surgery and for 72 hours after the surgery; the group Ⅲ was only treated with preventive use of antibiotics for 0.5 h before the surgery; the group Ⅳ was not treated with any antibiotics for prevention of nosocomial infection before and after the surgery. The white blood cell count, the percentage of neutrophils and the nosocoial infection rate after interventional therapy were compared among the four groups. RESULTS The nosocomial infection rate in group Ⅰ, Ⅱ and Ⅲ was significantly lower than that in group Ⅳ(P<0.05); the multidrug resistance rate in group Ⅰ was significantly higher than that in group Ⅱ, Ⅲ and Ⅳ(P<0.05); the abnormal rate of white blood cell count and percentage of neutrophils in group Ⅰ, Ⅱ and Ⅲ were significantly lower than those in group Ⅳ(P<0.05); the proportion of respiratory tract infection in the four groups was significantly higher than those of infections at the urinary tract, intervening site and blood stream in the same group after interventional therapy(P<0.05); hospitalization time in group Ⅰ, Ⅱ and Ⅲ was significantly shorter than that in group Ⅳ(P<0.05); cost-effectiveness in group Ⅰ, Ⅱ and Ⅲ was significantly lower than that in group Ⅳ, and that in group Ⅲ was less than that in group Ⅰ and Ⅱ(P<0.05). CONCLUSⅠON Preoperative preventive use of antibiotics for 0.5 h can effectively reduce the nosocomial infection rate after myocardial infarction intervention, but overuse can increase the drug resistance rate and increase the economic burden.
引文
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[20] Switaj TL,Christensen SR,Brewer DM.Acute coronary syndrome:current treatment[J].Am Fam Phys,2017,95(4):232-240.
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[2] Dasgupta S,Das S,Chawan NS,et al.Nosocomial infections in the intensive care unit:incidence,risk factors,outcome and associated pathogens in a public tertiary teaching hospital of Eastern India[J].Indian J Crit Care Med,2015,19(1):14-20.
[3] 赵文利,贾晓辉,张建红,等.急性心肌梗死患者急诊冠脉介入治疗术后医院感染病原学分析[J].中华医院感染学杂志,2017,27(8):1736-1742.
[4] Kulkarni R,Caskey J,Singh S,et al.Cigarette smoke extractexposed MRSA regulates leukocyte function for pulmonary persistence[J].Am J Respir Cell Molec Biol,2016,55(4):586-601.
[5] Kontos MC,Lanfear DE,Gosch K,et al.Prognostic value of serial N-terminal pro-brain natriuretic peptide testing in patients with acute myocardial infarction[J].Am J Cardiol,2017,120(2):181-185.
[6] Pierre-Louis B,Rodriques S,Gorospe V,et al.Clinical factors associated with early readmission among acutely decompensated heart failure patients[J].Arch Med Sci,2016,12(3):538-545.
[7] Hashemi-Jazi M,Hosseini SM,Gholamrezaei A.Factors associated with the no-reflow phenomenon following percutaneous intervention of saphenous vein coronary bypass grafts[J].ARYA Atheroscler,2017,13(5):221-229.
[8] Yun KH,Ko JS,Lee JM,et al.Correlations between high platelet reactivity,extent of coronary artery disease,and periprocedural myonecrosis in patients with acute coronary syndrome[J].Chonnam Med J,2017,53(2):147-152.
[9] Gastmeier P,Geffers C,Herrmann M,et al.Nosocomial infections and infections with multidrug-resistant pathogens-frequency and mortality[J].Dtsch Med Wochenschr,2016,141(6):421-426.
[10] 王明贵.广泛耐药革兰阴性菌感染的实验诊断,抗菌治疗及医院感染控制:中国专家共识[J].中国感染与化疗杂志,2017,17(1):82-92.
[11] 杨思源,陈树宝.心脏病学[M].4版,北京:人民卫生出版社,2012:23-25.
[12] 中国合格评定国家认可委员会.临床微生物检验程序验证指南[Z].CNAS-GL41:2016:518-520.
[13] 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.
[14] Song F,Yu M,Yang J,et al.Symptom-onset-to-balloon time,ST-segment resolution and in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention in China:from China Acute Myocardial Infarction Registry[J].Am J Cardiol,2016,118(9):1334-1339.
[15] 王广芬,王福斌,袁妍妩,等.个案追踪法在多重耐药菌防控中的效果评价[J].中国消毒学杂志,2016,33(1):87-89.
[16] Ren Y,Jia J,Sa J,et al.Association between N-terminal pro B-type natriuretic peptide and depressive symptoms in patients with acute myocardial infarction[J].Chin Med ( Engl),2017,130(5):542-548.
[17] 王永光,潘嘉西,章敏学,等.心肌梗死患者动脉介入治疗后医院感染危险因素分析[J].中华医院感染学杂志,2016,26(9):1999-2001.
[18] Thiele H,Akin I,Sandri M,et al.PCI strategies in patients with acute myocardial infarction and cardiogenic shock[J].NEng J Med,2017,377(25):2419-2432.
[19] Sra S,Tan MK,Mehta SR,et al.Ischemic and bleeding events in patients with myocardial infarction undergoing percutaneous coronary intervention who require oral anticoagulation:insights from the Canadian Observational Antiplatelet study[J].Am Heart J,2016,7(180):82-89.
[20] Switaj TL,Christensen SR,Brewer DM.Acute coronary syndrome:current treatment[J].Am Fam Phys,2017,95(4):232-240.
[21] Hausenloy DJ,Botker HE,Engstrom T,et al.Targeting reperfusion injury in patients with ST-segment elevation myocardial infarction:trials and tribulations[J].Eur Heart J,2017,38(13):935-941.
[22] Reichlin T,Cullen L,Parsonage WA,et al.Two-hour algorithm for triage toward rule-out and rule-in of acute myocardial infarction using high-sensitivity cardiac troponin T[J].Am J Med,2015,128(4):369-379.