75岁以上高龄患者心脏手术后重症监护医院感染分析

目的：调查重症监护病房高龄心脏手术患者术后医院感染及病原菌耐药性,以指导临床合理使用抗菌药物。方法：回顾性分析2005年1月至2012年10月,我院心脏外科75岁以上高龄患者术后医院感染临床资料,纸片扩散（K-B）法进行药敏实验。结果：2005年1月至2012年10月75岁以上高龄患者行开胸心脏手术1 361例,100例患者发生医院感染,感染率7.3%。合并糖尿病患者医院感染发生率显著高于非糖尿病患者;发生医院感染的高龄心脏手术患者住院时间、住院费用及病死率显著高于未发生医院感染的高龄患者。分离各种病原菌165株,其中呼吸道101株,占61.2%;血液29株,占17.6%;其他各类病原菌35株,占21.2%。革兰氏阴性菌中以鲍曼不动杆菌为主（20.6%）,革兰氏阳性菌中以表皮葡萄球菌为主（7.2%）,真菌中以白色假丝酵母菌为主（22.4%）。鲍曼不动杆菌显示多种药物为100%耐药。溶血性葡萄球菌及金黄色葡萄球菌显示多药耐药。呋喃妥因及万古霉素对革兰氏阳性球菌抗菌活性均为100%。结论：高龄心脏手术患者术后医院感染主要发生在呼吸道,耐药性逐渐增加,围手术期应合理使用抗菌药物,减轻患者负担,降低高龄患者住院病死率。

Analysis of nosocomial infection in elderly patients over 75 years old after cardiac surgery

Objective：To investigate the clinical distribution and antibiotics resistance of nosocomial pathogenic bacteria infection in elderly patients in ICU after cardiac surgery, in order to guide the clinical ra- tional use of antibiotics. Methods： The clinical data of hospital infection in patients over 75 years old from Jan- uary 2005 to October 2012 after cardiac surgery were retrospectively analyzed. Antibacterials susceptibility tes- ting was performed by Kirby-Bauer method. Results： There were 1 361 patients over 75 years old underwent cardiac surgery from January 2005 to October 2012, including 100 cases of these patients with hospital infec- tion, the infection rate was 7. 3%. The nosocomial infection rate in patients with diabetes was significantly higher than that in non-diabetic patients. The time of hospitalization, cost of hospitalization and mortality of eld- erly patients with nosocomial infection after heart operations were significantly higher than those of elderly pa- tients with non nosocomial infection. 165 strains of pathogenic bacteria were isolated, including 101 strain~ from respiratory tract （61.2%）; 29 strains from blood （17.6%）; other types were 35 strains, accounting for 21.2%. The majority of gram negative bacteria were acinetobacter （20. 6% ）. In gram positive bacteria, Staphylococcus epidermis was the most （7.2%）. The proportion of Candida albicans in fungus was 22. 4%. The resuh of bauman acinetobacter resistance showed that multidrug resistance was 100%. Staphylococcus hae- molyticus and Staphylococcus aureus showed multidrug resistance. The antibacterial activity of nitrofurantoin