冠心病患者PCI术后感染病原菌、耐药性及危险因素分析
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摘要
目的了解冠心病患者PCI术后医院感染病原菌及其耐药性,并进行危险因素分析。方法 2011年5月至2018年5月在本院接受PCI手术治疗的冠心病患者2000例,监测术后医院感染发生情况,对发生感染者取感染部位分泌物,按照《全国临床检验操作规程》采用常规方法进行病原菌的分离培养,进行菌种鉴定并检测其药物敏感性。记录患者的体质指数、基础疾病、心功能分级、感染部位及PCI手术的具体情况并进行分析。结果 2000例行PCI治疗冠心病患者中发生医院感染140例,感染率为7.00%,以呼吸道和泌尿系统感染常见,消化系统及其他部位感染较少发生。140例发生感染患者的感染部位分泌物中检出病原菌252株,其中G~-菌118株,占46.83%;G~+菌株110株,占43.65%;真菌24株,占9.52%。年龄较大、心功能分级高,接受侵入性操作,住院时间及PCI术治疗时间较长等为PCI术患者发生医院感染危险因素(OR分别为1.881,3.078,1.971,2.653,1.987,P<0.05)。检出的G~-菌对磺胺类、氟喹诺酮类、氨基糖苷类和第3代头孢呈不同程度耐药,耐药率为22.45%～60.10%;G~+菌对青霉素、复方磺胺甲噁唑和庆大霉素总体耐药率较高,为50.1%～96.3%;真菌中的白色假丝酵母菌对氟胞嘧啶耐药率100.00%。结论高龄、较高的心功能分级、接受侵入性操作,PCI手术时间及住院时间长等是冠心病患者PCI术后发生医院感染的危险因素,感染病原菌以G~+菌为主,且对常用抗菌药物有不同程度的耐药。在手术前进行针对性预防,治疗后及时检查感染病原菌种类及耐药性,以指导临床干预,避免药物滥用,这对于降低PCI术后并发症,提高冠心病患者生存质量有重大意义。
Objectives To investigate the pathogens causing a nosocomial infection after PCI in patients with coronary heart disease and their drug resistance and to analyze risk factors. Methods Two thousand patients with coronary heart disease who underwent PCI at this Hospital from May 2011 to May 2018 were monitored for a postoperative infection. Secretions were collected from the site of infection in accordance with the National Clinical Laboratory Procedures. Pathogens were isolated and cultured using conventional methods, and strains were identified and tested for drug sensitivity. The patient's body mass index, underlying disease, cardiac function grade, site of infection, and specifics of PCI were recorded and analyzed. Results A nosocomial infection developed in 140 of the 2 000 patients with coronary heart disease. The rate of infection was 7.00%. Respiratory and urinary tract infections were common while a gastrointestinal infection or infection of some other site was less common. Two hundred and fifty-two strains of pathogens were detected from the site of infection in the 140 infected patients, including 118 strains of Gram-negative bacteria, accounting for 46.83%; 110 strains of Gram-positive strain, accounting for 43.65%; and 24 strains of fungi, accounting for 9.52%. Being older, a higher grade of cardiac function, an invasive procedure, longer hospitalization, and a longer duration of PCI were risk factors for a nosocomial infection in patients who underwent PCI(OR 1.881, 3.078, 1.971, 2.653, 1.987, P<0.05). The detected Gram-negative bacteria had different degrees of resistance to sulfonamides, fluoroquinolones, aminoglycosides, and third-generation cephalosporins, with a resistance from 22.45-60.10%. Gram-positive bacteria were resistant to penicillin, a sulfamethoxazole compound, and gentamycin, with an overall resistance of 50.1-96.3%; the resistance of Candida albicans to flucytosine was 100.00%. Conclusion Being older, a higher grade of cardiac function, an invasive procedure, a long PCI, and long hospitalization are risk factors for a nosocomial infection in patients with coronary heart disease after PCI. The pathogens causing such an infection are mainly Gram-positive bacteria, and those bacteria have varying degrees of resistance to commonly used antibiotics. Targeted prevention before surgery, timely testing for infectious pathogens, and analysis of drug resistance can guide clinical interventions and avoid drug misuse. These approaches are crucial to reducing postoperative complications of PCI and improving the quality of life of patients with coronary heart disease.
Objectives To investigate the pathogens causing a nosocomial infection after PCI in patients with coronary heart disease and their drug resistance and to analyze risk factors. Methods Two thousand patients with coronary heart disease who underwent PCI at this Hospital from May 2011 to May 2018 were monitored for a postoperative infection. Secretions were collected from the site of infection in accordance with the National Clinical Laboratory Procedures. Pathogens were isolated and cultured using conventional methods, and strains were identified and tested for drug sensitivity. The patient's body mass index, underlying disease, cardiac function grade, site of infection, and specifics of PCI were recorded and analyzed. Results A nosocomial infection developed in 140 of the 2 000 patients with coronary heart disease. The rate of infection was 7.00%. Respiratory and urinary tract infections were common while a gastrointestinal infection or infection of some other site was less common. Two hundred and fifty-two strains of pathogens were detected from the site of infection in the 140 infected patients, including 118 strains of Gram-negative bacteria, accounting for 46.83%; 110 strains of Gram-positive strain, accounting for 43.65%; and 24 strains of fungi, accounting for 9.52%. Being older, a higher grade of cardiac function, an invasive procedure, longer hospitalization, and a longer duration of PCI were risk factors for a nosocomial infection in patients who underwent PCI(OR 1.881, 3.078, 1.971, 2.653, 1.987, P<0.05). The detected Gram-negative bacteria had different degrees of resistance to sulfonamides, fluoroquinolones, aminoglycosides, and third-generation cephalosporins, with a resistance from 22.45-60.10%. Gram-positive bacteria were resistant to penicillin, a sulfamethoxazole compound, and gentamycin, with an overall resistance of 50.1-96.3%; the resistance of Candida albicans to flucytosine was 100.00%. Conclusion Being older, a higher grade of cardiac function, an invasive procedure, a long PCI, and long hospitalization are risk factors for a nosocomial infection in patients with coronary heart disease after PCI. The pathogens causing such an infection are mainly Gram-positive bacteria, and those bacteria have varying degrees of resistance to commonly used antibiotics. Targeted prevention before surgery, timely testing for infectious pathogens, and analysis of drug resistance can guide clinical interventions and avoid drug misuse. These approaches are crucial to reducing postoperative complications of PCI and improving the quality of life of patients with coronary heart disease.
引文
[1] Kahkonen O,Saaranen T,Lamidi M L,et al.Perceived health among patients with coronary heart disease four months after a percutaneous coronary intervention[J].Int J Car Sci,2017,10(1):559.
[2] K?hk?nen O,Saaranen T,Kankkunen P,et al.Predictors of adherence to treatment by patients with coronary heart disease after percutaneous coronary intervention[J].J Clin Nurs,2018,27(5-6):989-1003.
[3] Waldo S W,McCabe J M,Kennedy K F,et al.Quality of Care at hospitals identified as outliers in publicly reported mortality statistics for percutaneous coronary intervention [J].Circulation,2017,135(20):1897-907.
[4] 王青,许晨耘,王瑜,等.急诊 PCI 患者医院感染因素分析与对策[J].中国消毒学杂志,2015 (7):726-8.
[5] 温书敏,林德智,袁权,等.冠心病患者急诊PCI术后医院感染病原菌特点及相关因素分析[J].中华医院感染学杂志,2018,28(20):3080-3.
[6] Nguyen AV,Kamel MG,Abdelrahman SAM,et al.Optimal percutaneous coronary intervention in patients with ST-elevation myocardial infarction and multivessel disease:An updated,large-scale systematic review and meta-analysis[J].Int J Cardiol,2017,244:67-76.
[7] 陈鹏,邢大伟,李嘉.急性心肌梗死患者直接经皮冠状动脉介入术后感染原因分析及预防措施[J].中华医院感染学杂志,2011,21(12):2418-20.
[8] Rimac G,Fearon WF,De Bruyne B,et al.Clinical value of post-percutaneous coronary intervention fractional flow reserve value:A systematic review and meta-analysis[J].Am Heart J,2017,183:1-9.
[9] 何雯婕.老年冠心病患者医院感染的危险因素[J].中外医学研究,2018,16(23):150-1.
[2] K?hk?nen O,Saaranen T,Kankkunen P,et al.Predictors of adherence to treatment by patients with coronary heart disease after percutaneous coronary intervention[J].J Clin Nurs,2018,27(5-6):989-1003.
[3] Waldo S W,McCabe J M,Kennedy K F,et al.Quality of Care at hospitals identified as outliers in publicly reported mortality statistics for percutaneous coronary intervention [J].Circulation,2017,135(20):1897-907.
[4] 王青,许晨耘,王瑜,等.急诊 PCI 患者医院感染因素分析与对策[J].中国消毒学杂志,2015 (7):726-8.
[5] 温书敏,林德智,袁权,等.冠心病患者急诊PCI术后医院感染病原菌特点及相关因素分析[J].中华医院感染学杂志,2018,28(20):3080-3.
[6] Nguyen AV,Kamel MG,Abdelrahman SAM,et al.Optimal percutaneous coronary intervention in patients with ST-elevation myocardial infarction and multivessel disease:An updated,large-scale systematic review and meta-analysis[J].Int J Cardiol,2017,244:67-76.
[7] 陈鹏,邢大伟,李嘉.急性心肌梗死患者直接经皮冠状动脉介入术后感染原因分析及预防措施[J].中华医院感染学杂志,2011,21(12):2418-20.
[8] Rimac G,Fearon WF,De Bruyne B,et al.Clinical value of post-percutaneous coronary intervention fractional flow reserve value:A systematic review and meta-analysis[J].Am Heart J,2017,183:1-9.
[9] 何雯婕.老年冠心病患者医院感染的危险因素[J].中外医学研究,2018,16(23):150-1.