心血管外科ICU 66例心脏移植患者医院感染发病率

目的了解心血管外科重症监护病房（ICU）心脏移植患者医院感染情况和病原学特点。方法对2013年7月1日—2014年6月30日某医院心脏移植住院患者进行目标性监测。结果心血管外科ICU 66例心脏移植患者共发生医院感染16例（18例次），ICU医院感染发病率为24.24%。其医院感染发病率(24.24%)、VAP发病率(7.58%)均高于非移植患者(分别为6.24%、1.72%)（χ2值分别为33.718、12.199，均P＜0.001）。其中下呼吸道7例次，呼吸机相关肺炎（VAP）6例次,菌血症3例次,表浅切口和皮肤软组织感染各1例次。分离病原菌：真菌8株，肺炎克雷伯菌3株，金黄色葡萄球菌和鲍曼不动杆菌各2株，阴沟肠杆菌、溶血不动杆菌和弗劳地柠檬酸杆菌各1株。结论心脏移植患者医院感染发病率较高，主要感染类型为下呼吸道感染，主要病原体为真菌。

Incidence of healthcare associated infection in 66 patients undergoing heart transplantation in a cardiovascular surgical intensive care unit

ObjectiveTo understand the status and pathogenic characteristics of healthcare associated infection (HAI) in cardiovascular surgical intensive care unit (ICU) patients undergoing heart transplantation.MethodsPatients who underwent heart transplantation in a hospital between July 1, 2013 and June 30, 2014 were performed targeted monitoring.ResultsOf 66 patients undergoing heart transplantation, 16 developed 18 times of HAI, incidence of HAI was 24.24%. Incidence of HAI and ventilator associated pneumonia(VAP) in patients undergoing heart transplantation were both higher than non transplantation patients (24.24% vs 6.24%, χ2=33.718; 7.58% vs 1.72%, χ2=12.199，respectively, both P＜0.001）.The infection tyes were as follows: lower respiratory tract infection(n=7)， VAP (n=6), bacteremia (n=3), superficial incision infection (n=1), as well as skin and soft tissue infection (n=1). The isolated pathogens were fungus (n=8), Klebsiella pneumoniae(n=3), Staphylococcus aureus (n=2), Acinetobacter baumannii (n=2), Enterobacter cloacae (n=1), Acinetobacter haemolyticus (n=1), and Citrobacter freundii (n=1).ConclusionIncidence of HAI is high in patients undergoing heart transplantation, the main infection type is lower respiratory tract infection, the major pathogen is fungus.