EARLY NOSOCOMIAL INFECTIONS IN PEDIATRIC CARDIOVASCULAR-SURGERY PATIENTS
EARLY NOSOCOMIAL INFECTIONS IN PEDIATRIC CARDIOVASCULAR-SURGERY PATIENTS
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DOI：
10.1097/00003246-199004000-00006
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发表时间：
1990-04-01
影响因子：
8.8
通讯作者：
BARKER, GA
中科院分区：
文献类型：
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作者：
POLLOCK, EMM;FORDJONES, EL;BARKER, GA
1987年7月1日至1988年2月29日期间接受心血管手术的所有患者自入住儿科重症监护病房（PICU）起每天均由重症监护师/麻醉师进行随访。患者入院时通过手术过程和 PRISM 评分进行表征。在 310 名患者中，40 名患者（院内感染率 12.9）在手术后 2 个月内发生了 78 例感染（院内感染率 25.2），其中 28%（n = 22）是伤口。闭合性非泵病例中出现早期伤口感染的比例为 8%，开放式泵病例中出现早期伤口感染的比例为 6.7%。如果病房内胸骨开放（选择性或急诊）（27.6% 开放 vs. 5.0% 封闭，p < .001）或 PRISM 评分为 .gtoreq，则伤口感染的可能性更大。入院 PICU 时为 10（10.7% ≥ 10 vs. 2.3% < 10，p < .01）。封闭式病例中伤口感染的病原体是金黄色葡萄球菌（70%）和凝固酶阴性葡萄球菌（CONS）（30%），而开放式、泵式病例中伤口感染的病原体是 CONS（33%）、铜绿假单胞菌（27%）、念珠菌属。 (27%) 和金黄色葡萄球菌 (20%)。非伤口感染占感染的 72% (n = 56)。菌血症和其他中枢和动脉导管相关感染的发生率与伤口感染的发生率接近，为 6.8/100 名患者。如果胸骨在病房内保持开放、患者在 PICU 入院时以及接受特定外科手术后 PRISM 评分较高，则伤口感染的可能性更大。
All patients undergoing cardiovascular surgery between July 1, 1987 and February 29, 1988 were followed from admission to the pediatric ICU (PICU) daily by an intensivist/anesthetist. Patients were characterized by surgical procedure and PRISM score on ICU admission. Of 310 patients, 40 patients (nosocomially infected patient ratio 12.9) developed 78 infections (nosocomial infection ratio 25.2), of which 28% (n = 22) were wounds, within 2 months of surgery. Early wound infection followed 8% of closed, nonpump cases and 6.7% of open, pump cases. Wound infection was more likely if the sternum was open on the ward (elective or emergency) (27.6% open vs. 5.0% closed, p < .001) or if the PRISM score was .gtoreq. 10 on PICU admission (10.7% .gtoreq. 10 vs. 2.3% < 10, p < .01). The causative agents in wound infections in closed cases were Staphylococcus aureus (70%) and coagulase negative staphylococci (CONS) (30%) while in open, pump cases the agents were CONS (33%), Pseudomonas aeruginosa (27%), Candida spp. (27%), and S. aureus (20%). Nonwound infections accounted for 72% of infections (n = 56). The number of bacteremias and other central and arterial line-related infections approximated wound infection in incidence at 6.8/100 patients. Wound infections are more likely if the sternum has been left open on the ward, if the patient has a high PRISM score on PICU admission, and after specific surgical procedures.