摘要
目的探讨主动脉夹层腔内隔绝术后多药耐药菌(MDRO)感染的危险因素及其预防性策略.方法选取2018年1月-2022年12月绍兴市人民医院行主动脉夹层腔内隔绝术患者220例为研究对象,根据患者术后MDRO感染情况分为MDRO感染组(n=25)和无MDRO感染组(n=195);收集行主动脉夹层腔内隔绝术患者的临床资料,对MDRO感染患者进行标本采集、病原菌检测及药敏试验,并统计MDRO感染现况及病原菌特点,分析MDRO感染主要病原菌的耐药情况,采用多因素Logistic回归分析法分析主动脉夹层腔内隔绝术后患者MDRO感染的危险因素.结果220例主动脉夹层腔内隔绝术后患者中MDRO感染25例,感染率为11.36%;共培养分离病原菌26株,其中革兰阴性菌20株占76.92%,以肺炎克雷伯菌、鲍氏不动杆菌为主;革兰阳性菌5株占19.23%;真菌1株占3.85%;肺炎克雷伯菌对磺胺甲噁唑/甲氧苄啶、头孢唑林等耐药严重,对替加环素、阿米卡星较敏感;鲍氏不动杆菌对环丙沙星、磺胺甲噁唑/甲氧苄啶耐药严重,对左氧氟沙星、替加环素较敏感;年龄、术前美国纽约心脏病学会(NYHA)分级是主动脉夹层腔内隔绝术后MDRO感染的危险因素(P<0.05).结论主动脉夹层腔内隔绝术后患者MDRO感染率较高,以肺炎克雷伯菌和鲍氏不动杆菌为主,肺炎克雷伯菌对磺胺甲噁唑/甲氧苄啶、头孢唑林等耐药严重,对替加环素、阿米卡星较敏感;鲍氏不动杆菌对环丙沙星、磺胺甲噁唑/甲氧苄啶耐药严重,对左氧氟沙星、替加环素较敏感.临床可根据危险因素采取针对性治疗及干预措施.
OBJECTIVE To investigate the risk factors for multidrug-resistant bacteria(MDRO)infection after en-doluminal isolation of aortic dissection and its preventive strategies.METHODS A total of 220 patients who under-went endoluminal isolation of aortic dissection in Shaoxing People's Hospital from Jan.2018 to Dec.2022 were se-lected as the study subjects,and the patients were divided into the MDRO infection group(n=25 cases)and the non-MDRO infection group(n=195 cases)according to their postoperative MDRO infection.Clinical data of pa-tients undergoing endoluminal isolation of aortic dissection were collected,samples were collected,pathogen de-tection and drug sensitivity tests were performed on patients with MDRO infection,and MDRO infection status and pathogen characteristics were analyzed,and drug resistance of major pathogens of MDRO infection was ana-lyzed.Multivariate logistic regression analysis was used to analyze the risk factors of MDRO infection in patients after endoluminal isolation of aortic dissection.RESULTS Among 220 patients after endoluminal isolation of aortic dissection,25 patients were infected with MDRO,with an infection rate of 11.36%.A total of 26 strains were cul-tured and isolated,of which 20 strains of gram-negative accounted for 76.92%,mainly Klebsiella pneumoniae and Acinetobacter baumannii.5 strains of gram-positive accounted for 19.23%.One strain of fungus accounted for 3.85%.Klebsiella pneumoniae was highly resistant to sulfamethoxazole,trimethoprim and cefazolin,and more sensitive to tigecycline and amikacin.Acinetobacter baumannii was highly resistant to ciprofloxacin,sulfamethox-azole/trimethoprim,and more sensitive to levofloxacin and tigecycline.Age and preoperative New York College of Cardiology(NYHA)grading were the risk factors for MDRO infections after endoluminal isolation of aortic dis-section(P<0.05).CONCLUSION The infection rate of MDRO patients after endoluminal isolation of aortic dis-section was high,with Klebsiella pneumoniae and Acinetobacter baumannii being predomin
作者
徐钰
唐黎明
马玉亮
黄洪亮
裘秋月
XU Yu;TANG Li-ming;MA Yu-liang;HUANG Hong-liang;QIU Qiu-yue(Shaoxing People's Hospital,Shaoring,Zhejiang 312000,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2024年第3期386-389,共4页
Chinese Journal of Nosocomiology
基金
浙江省科技厅基金资助项目(2018C37103)。
关键词
主动脉夹层
腔内隔绝术
多药耐药菌感染
病原菌
耐药
危险因素
Aortic dissection
Endovascular isolation
Multiple drug resistant bacteria infection
Pathogenic bacteria
Drug resistance
Risk factor
