切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2022, Vol. 08 ›› Issue (03) : 196 -202. doi: 10.3877/cma.j.issn.2096-1537.2022.03.002

所属专题: 重症医学

专家论坛

心脏外科术后感染的诊断和抗菌治疗
刘正琴1, 翟茜1,()   
  1. 1. 250012 济南,山东大学齐鲁医院心外ICU
  • 收稿日期:2022-04-13 出版日期:2022-08-28
  • 通信作者: 翟茜

Diagnosis and antibiotic therapy of postoperative infection after cardiac surgery

Zhengqin Liu1, Qian Zhai1,()   

  1. 1. Department of Extracardiac ICU, Qilu Hospital of Shandong University, Jinan 250012, China
  • Received:2022-04-13 Published:2022-08-28
  • Corresponding author: Qian Zhai
引用本文:

刘正琴, 翟茜. 心脏外科术后感染的诊断和抗菌治疗[J/OL]. 中华重症医学电子杂志, 2022, 08(03): 196-202.

Zhengqin Liu, Qian Zhai. Diagnosis and antibiotic therapy of postoperative infection after cardiac surgery[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(03): 196-202.

感染是心脏外科术后常见的并发症之一,严重影响患者预后,甚至导致死亡。目前,对于心脏外科术后感染的诊治仍然存在一定的误区,亟待解决。本文结合国内外感染相关指南以及国内心血管外科术后医院感染的发生部位、病原学分布及耐药性特点,系统梳理了心脏外科术后常见感染的诊疗过程,以期规范心脏外科术后抗菌药物的合理使用、提升感染治愈率、降低病死率、减少细菌耐药率。

Infection is one of the commonest complications after cardiac surgery, which associated with increased the length of ICU stay, healthcare costs and mortality. At present, there are still some misunderstanding in the diagnosis and treatment of infection after cardiac surgery, which need to be solved urgently. We outline the clinical process of diagnosis-treatment-reassessment-adjustment and standardize physician's behavior for postoperative infection based on the recent guidelines and consensus, in order to improve the antibiotic management, decrease the infection rate and bacterial resistance after cardiac surgery.

图1 心脏外科术后感染诊疗流程及疗效评估注:CRP为C反应蛋白;PCT为降钙素原;TTE为经胸心脏彩超;TEE为经食管心脏彩超;MDR为多重耐药菌;MSSA为甲氧西林敏感的金黄色葡萄球菌;CoNS为凝固酶阴性;VSD为负压封闭引流;ESBLs为超广谱β-内酰胺酶;MRSA为耐甲氧西林金黄色葡萄球菌;PK为药物代谢动力学;RRT为肾替代治疗;PD为药物效应动力学;IE为感染性心内膜炎
1
Browm PP, Kugelmass AD, Cohen DJ, et al. The frequency and cost of complications associated with coronary artery bypass grafting surgery: results from the United States Medicare program [J]. Ann Thorac Surg, 2008, 85(6): 1980-1986.
2
Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012 [J]. Crit Care Med, 2013, 41(2): 580-637.
3
翟茜,胡波,郑瑞强,等. 重症感染诊疗流程 [J/OL]. 中华重症医学电子杂志, 2017, 3(2): 127-132.
4
曹芳芳, 张海涛, 张永辉. 成人心血管外科重症监护病房医院感染情况的临床研究 [J]. 中国分子心脏病学杂志, 2018, 18(5): 2609-2611.
5
刘苏, 陈淑敏, 李晓恒, 等. 10年心脏手术后感染调查分析 [J]. 中华医院感染学杂志, 2003, 13(5): 433-435.
6
Kollef M, Sharpless L, Vlasnik J, et al. The impact of nosocomial infections on patient outcomes following cardial surgery [J]. Chest, 1997, 122: 666-675.
7
刘恋, 陈榕, 夏中元, 等. 乌司他丁降低体外循环术后患者炎性反应的系统评价 [J]. 山西医科大学学报, 2016, 47(7): 653-657.
8
Harbarth S, Holeckova K, Froidevaux C, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis [J]. Am J Respir Crit Care Med, 2001, 164(3): 396-402.
9
Du B, Pan J, Chen D, et al. Serum procalcitonin and interleukin-6 levels may help to differentiate systemic inflammatory response of infectious and non-infectious origin [J]. Chin Med J (Engl), 2003, 116(4): 538-542.
10
Uzzan B, Cohen R, Nicolas P, et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis [J]. Crit Care Med, 2006, 34(7): 1996-2003.
11
王郝, 崔娜, 隆云, 等. 降钙素原对心脏外科术后重症患者感染的早期预测价值 [J]. 中华危重病急救医学, 2017, 29(10): 987-901.
12
胡亚兰, 郑华, 张绵. 心脏术后降钙素原变化的临床意义 [J]. 中国实用医刊, 2017, 44(21): 32-35.
14
党海明, 宋跃, 曹剑, 等. 心脏手术患者医院内感染致病菌分布与耐药性分析 [J]. 中华流行病学杂志, 2013, 34(5): 484-487.
15
中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版) [J]. 中华结核和呼吸杂志, 2018, 41(4): 255-280.
18
陈浩, 梅运清. 心脏外科术后感染 [J]. 心血管外科杂志, 2016, 5(2): 5-7.
19
中华人民共和国卫生部. 医院感染诊断标准(试行) [J]. 中华医学杂志, 2001, 81(5): 314-320.
20
黄勋, 吴安华, 等. 多重耐药菌医院感染预防与控制中国专家共识 [J]. 中国感染控制杂志, 2015, 14(1): 1-9.
23
崔振田, 高永顺, 陆龙. 胸大肌肌瓣 翻转成形术治疗心脏外科手术后胸骨感染247例 [J]. 中华胸心血管外科杂志, 2018, 34(6): 359-361.
25
王蔚莎, 侯铁英, 等. 心脏手术后真菌感染病原学特征与危险因素分析 [J]. 中国实验诊断学, 2017, 21(7): 1137-1140.
26
中华医学会重症医学分会. 重症患者侵袭性真菌感染诊断与治疗指南 [J]. 中华内科杂志, 2007, 46(11): 960-966.
30
中华医学会呼吸病学分会. 支气管肺泡灌洗液细胞学检测技术规范(草案) [J]. 中华结核和呼吸杂志, 2002, 25(7) : 390.
13
Michalopoulos A, Geroulanos S, Rosmarakis ES, et al. Frequency, characteristics, and predictors of microbiologically documented nosocomial infections after cardiac surgery [J]. Eur J Cardiothorac Surg, 2006, 29(4): 456-460.
16
Edwardson S, Cairns C. Nosocomial infections in the ICU [J]. Anaesth Intensive Care, 2019, 20(1): 14-18.
17
Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis [J]. Eur Heart J, 2015, 36(44): 3075-3128.
21
Chaves F, Garnacho-Montero J, Del Pozo JL, et al. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) [J]. Med Intensiva (Engl Ed), 2018, 42(1): 5-36.
22
Massimo S, Xavier G, Hardcastle TC, et al. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections [J]. World J Emerg Surg, 2018, 13(1): 1-24.
24
de Cueto M, Aliaga L, Alós JI, et al. Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) [J]. Enferm Infecc Microbiol Clin, 2017, 35(5): 314-320.
27
Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of Candidiasis: 2016 Update by the Infectious Diseases Society of America [J]. Clin Infect Dis, 2016, 62(4): e1-e50.
28
Patterson TF , Thompson GR, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America [J]. Clin Infect Dis, 2016, 63 (4): e1-e60.
29
De Pauw B, Walsh TJ, Donnelly JP. European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group,et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive [J].Clin Infect Dis, 2008, 46(12): 1813-1821.
31
Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future [J]. BMC Med, 2019, 9: 107.
[1] 王亚红, 蔡胜, 葛志通, 杨筱, 李建初. 颅骨骨膜窦的超声表现一例[J/OL]. 中华医学超声杂志(电子版), 2024, 21(11): 1089-1091.
[2] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[3] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[4] 赵林娟, 吕婕, 王文胜, 马德茂, 侯涛. 超声引导下染色剂标记切缘的梭柱型和圆柱型保乳区段切除术的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 634-637.
[5] 熊鹰, 林敬莱, 白奇, 郭剑明, 王烁. 肾癌自动化病理诊断:AI离临床还有多远?[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 535-540.
[6] 杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.
[7] 袁雨涵, 杨盛力. 体液和组织蛋白质组学分析在肝癌早期分子诊断中的研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 883-888.
[8] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[9] 郑大雯, 王健东. 胆囊癌辅助诊断研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 769-773.
[10] 王秋生. 胆道良性疾病诊疗策略[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 779-782.
[11] 李浩, 陈棋帅, 费发珠, 张宁伟, 李元东, 王硕晨, 任宾. 慢性肝病肝纤维化无创诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 863-867.
[12] 谭瑞义. 小细胞骨肉瘤诊断及治疗研究现状与进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 781-784.
[13] 王子阳, 王宏宾, 刘晓旌. 血清标志物对甲胎蛋白阴性肝细胞癌诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 677-681.
[14] 陈慧, 邹祖鹏, 周田田, 张艺丹, 张海萍. 皮肤镜对头皮红斑性皮肤病辅助鉴别诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 692-698.
[15] 胡云鹤, 周玉焯, 付瑞瑛, 于凡, 李爱东. CHS-DRG付费制度下GB1分组住院费用影响因素分析与管理策略探讨[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 568-574.
阅读次数
全文


摘要