2023 年第 7 期 第 18 卷

心脏外科术后多重耐药菌感染的临床特征与危险因素

Clinical characteristics and risk factors of multidrug-resistant bacteria infection after cardiac surgery

作者：武元星任建伟朱光发

英文作者：Wu Yuanxing Ren Jianwei Zhu Guangfa

单位：首都医科大学附属北京安贞医院呼吸与危重症医学科，北京100029

英文单位：Department of Respiratory and Critical Care Medicine Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：术后感染；多重耐药菌；临床特征；危险因素；耐药性

英文关键词：Postoperativeinfection;Multidrug-resistantbacteria;Clinicalcharacteristics;Riskfactors;Drugresistance

• 摘要：

• 目的  探究心脏外科术后多重耐药菌（MDRB）感染的临床特征与危险因素。方法  收集2019年1月至2021年10月首都医科大学附属北京安贞医院心脏外科术后275例医院获得性感染患者的完整病历资料进行回顾性研究。根据其临床标本是否检出MDRB分为MDRB组（129例）和非MDRB组（146例）。比较2组患者的临床特征和对临床常用抗菌药物的耐药性。采用单因素分析方法分析MDRB感染的危险因素，采用二元Logistic回归方法进行多因素分析确定MDRB感染的独立危险因素。结果  275例患者中，确诊为MDRB感染患者纳入MDRB组（129例，46.9%），非MDRB感染患者纳入非MDRB组（146例，53.1%）。MDRB组患者男性和冠心病（冠状动脉粥样硬化性心脏病）比例低于非MDRB组，瓣膜性疾病比例高于非MDRB组，感染前住院时间长于非MDRB组，差异均有统计学意义（均P＜0.05）。单因素分析结果显示，MDRB组患者手术时间短于非MDRB组，重症监护室停留时间和总住院时间长于非MDRB组，血白蛋白＜30 g/L、肾功能不全以及碳青霉烯、万古霉素和抗菌药物联合应用比例高于非MDRB组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，血白蛋白＜30 g/L和肾功能不全为MDRB感染的独立危险因素（比值比=4.260，95%置信区间：1.624～11.175，P＜0.05；比值比=192.684，95%置信区间：56.524～656.840，P＜0.05）。结论  心脏外科术后MDRB感染延长患者的总住院时间，增加经济负担，而且严重影响预后。加强患者的围手术期管理，合理谨慎地使用抗菌药物以及充分了解术后MDRB感染发生的危险因素对于降低感染的发生率和病死率以及改善预后具有重要意义。

• Objective  To explore the clinical characteristics and risk factors of multidrug-resistant bacteria (MDRB) infection after cardiac surgery. Methods  The complete medical records of 275 patients with hospital-acquired infection after cardiac surgery in Beijing Anzhen Hospital, Capital Medical University from January 2019 to October 2021 were collected for retrospective study. They were divided into MDRB group (129 cases) and non-MDRB group (146 cases) according to whether MDRB was detected in clinical specimens. The clinical characteristics and drug resistance to commonly used antibiotics were compared between the two groups. Univariate analysis was used to analyze the risk factors of MDRB infection, and binary Logistic regression was used to determine the independent risk factors of MDRB infection. Results  Among 275 patients, patients diagnosed with MDRB infection were included in the MDRB group (129 cases, 46.9%), and patients without MDRB infection were included in the non-MDRB group (146 cases, 53.1%). The proportions of male and coronary atherosclerotic heart disease in MDRB group were lower than those in non-MDRB group, the proportion of valvular disease was higher than that in non-MDRB group, and the length of hospital stay time before infection was longer than that in non-MDRB group (all P<0.05). Univariate analysis showed that the operation time in MDRB group was shorter than that in non-MDRB group, the intensive care unit stay time and total hospital stay time were longer than those in non-MDRB group, and the proportion of serum albumin<30 g/L, renal insufficiency, carbapenem, vancomycin and combination of antimicrobial agent were higher than those in non-MDRB group (all P<0.05). Multivariate Logistic regression analysis showed that serum albumin<30 g/L and renal insufficiency were independent risk factors for MDRB infection (odds ratio=4.260, 95%confidence interval: 1.624-11.175; odds ratio=192.684, 95%confidence interval: 56.524-656.840; both P<0.05). Conclusion  MDRB infection after cardiac surgery extends the total hospital stay time, increases the financial burden, and significantly affects the prognosis. It is important to strengthen the perioperative management of patients, rationally and prudently use antibiotics and fully understand the risk factors of postoperative MDRB infection for reducing the incidence and mortality of infection and improving the prognosis.