| Background:At present,most cardiovascular surgery（CVS）diseases,which are need surgical treatment to save lives,to prolong the survival rate and to improve the quality of life.Cardiovascular surgery has the following characteristics:large wound,long operation duration,cardiopulmonary bypass（CPB）during operation,and various invasive operations such as tracheal intubation,central venous puncture and catheterization,catheterization,and even ECMO,IABP,CRRT and many other invasive adjuvant treatment measures.In addition,coupled with the patient’s own factors,patients admitted to cardiovascular surgery often have acute onset and serious illness,most of them are middle-aged and elderly patients,and they are often accompanied by various basic diseases such as hypertension,diabetes,respiratory and liver and kidney dysfunction,which can lead to delayed recovery and malnutrition after operation.The above factors can greatly increase the incidence of nosocomial infection.Antibiotics play a vital role in the treatment of nosocomial infection.However,in recent years,the drug resistance of pathogenic bacteria has been increasing,and even the phenomenon of multiple drug resistance.Hospital infection after cardiovascular surgery,especially the infection of drug-resistant bacteria,not only prolongs the patient’s hospitalization time,increases medical expenses,complicates the clinical diagnosis and treatment and nursing work,reduces the hospital bed tension and turnover rate,but also directly threatens the patient’s health and life,and even leads to the patient’s long-term disability or death.Understanding the epidemiological characteristics of postoperative infection in cardiovascular surgery,which can control the occurrence of postoperative nosocomial infection after cardiovascular surgery.Objective:This study will explore the epidemiological characteristics of postoperative infection in cardiovascular surgery,so as to guide the rational use of antibiotics in clinic and to control of nosocomial infection.Methods:This study retrospectively analyzed the clinical data of patients after cardiovascular surgery in the Second Hospital of Jilin University from January 2018 to December 2020.According to the culture results of sputum,blood,catheter,incision and urine,the distribution characteristics,drug resistance and changing trend of pathogenic bacteria were analyzed.Results:The total number of patients in cardiovascular surgery in our hospital was 2410from 2018 to 2020,and the total number of patients with nosocomial infection after operation was 535,with an overall infection rate of 22.20%.The nosocomial infection rates in 2018,2019 and 2020 were 26.76%（186/695）,26.02%（203/780）and15.61%（146/935）respectively,and there was a statistical difference among the three years（χ~2=38.46,P<0.05）.A total of 768 strains of pathogenic bacteria were detected in all samples of sputum,blood,catheter,incision and urine taken from infected patients in the past three years.The number of pathogenic bacteria detected in2018,2019 and 2020 were 276（35.94%）,299（38.93%）and 193（25.13%）respectively,and there was a statistical difference between the detection rates of samples in three years（χ~2=36.43,P<0.05）.The detection rates in each quarter were20.96%（161/768）,32.03%（246/768）,25.00%（192/768）and 22.01%（169/768）respectively,and there are differences among the detection rates in each quarter（χ~2=30.60,P<0.05）,and the detection rate is higher in the second quarter.Among the 768 pathogenic bacteria detected,518（66.33%）were from sputum samples,146（20.35%）from catheter samples,86（11.01%）from blood samples,15（1.92%）from incision secretion samples and 3（0.38%）from urine samples.Sputum samples accounted for 56.88%（157/276）,67.89%（203/299）and 81.87%（158/193）in 2018,2019 and 2020,respectively.The detection rate of sputum samples showed an increasing trend,and the difference was statistically significant（χ~2=32.33,P<0.05）.The detection rates of catheter specimens in three years were 28.99%（80/276）,18.06%（54/299）and 6.22%（12/193）,respectively.The detection rates of catheter specimens showed a decreasing trend year by year,with statistical difference（χ~2=38.53,P<0.05）.The detection rates of blood samples in three years were 12.68%（35/276）,11.37%（34/299）and 8.81%（17/193）,respectively.The detection rates of blood samples showed a decreasing trend year by year,but the difference is not statistically significant（χ~2=1.73,P>0.05）.The detection rates of secretion specimens in three years were 1.45%（4/276）,2.34%（7/299）and 2.07%（4/193）respectively,and there was no statistical difference between them（χ2=0.62P>0.05）.The detection rates of urine samples in three years were 0.00%（0/276）,0.33%（1/299）and 1.04%（2/193）,respectively.There was no statistical difference between the detection rates of urine samples in three years（χ~2=3.17,P>0.05）.Among the 768 strains of pathogenic bacteria detecte,gram-negative bacteria（G-bacteria）accounted for 64.32%（494strains）,gram-positive bacteria（G+bacteria）accounted for 23.70%（182 strains）,fungi accounted for 11.98%（92 strains）,and there was a statistical difference among the proportions of G-bacteria,G+bacteria and fungi（χ~2=521.58,P<0.05）.The detection rates of G-bacteria in 2018,2019 and 2020 were 60.87%（168/276）,61.20%（183/299）and 73.58%（142/193）respectively,and the detection rates of G-bacteria showed an upward trend in the past three years,with statistical differences（χ~2=9.88,P<0.05）.The detection rates of G+bacteria in 2018,2019 and 2020were 28.26%（78/276）,24.08%（72/299）and 17.10%（33/193）respectively.The detection rates of G+bacteria were decreasing year by year in three years,and the difference was statistically significant（χ~2=7.81,P<0.05）.The detection rates of fungi in 2018,2019 and 2020 were 10.87%（30/276）,14.72%（44/299）and 9.33%（18/193）,respectively.There was a difference among the detection rates of fungi in three years,but there was no statistical significance（χ~2=3.73,P>0.05）.The top five G-bacteria detected were Klebsiella Pneumoniae（21.26%,105/494）,Pseudomonas Aeruginosa（20.65%,102/494）,Enterobacter cloacae（17.41%,86/494）and Acinetobacter Baumannii（10.32%,51）.The detection rates of Klebsiella Pneumoniae in 2018,2019 and 2020 were 13.41%（37/276）,11.71%（35/299）and 17.10%（33/193）respectively,and there was no statistical difference between the detection rates of Klebsiella Pneumoniae in the past three years（χ~2=2.01,P>0.05）.The detection rates of Pseudomonas Aeruginosa in 2018,2019and 2020 were 9.06%（25/276）,16.05%（48/299）and 15.03%（29/193）respectively,and there was a statistical difference between the detection rates of Pseudomonas Aeruginosa in three years（χ~2=6.78,P<0.05）.The detection rates of Enterobacter Cloacae in 2018,2019 and 2020 were 9.27%（27/276）,11.71%（35/299）and 12.44%（24/193）respectively,and there was no statistical difference between the detection rates of Enterobacter cloacae in the past three years（χ~2=0.93,P>0.05）.The detection rates of Acinetobacter Baumannii in 2018,2019and 2020 were 10.87%（30/276）,4.01%（12/299）and 4.66%（9/193）respectively,and Acinetobacter baumannii showed a decreasing trend year by year,which was statistically significant（χ~2=12.51,P<0.05）.No CRKP detected,CRPA was 32.32%,CRE was 1.16%,CRAB was 54.91%.The main G+bacteria were Staphylococcus Epidermidis（35.16%,64/182）,Staphylococcus Aureus（14.84%,27/182）,Staphylococcus Aureus Subspecies Humanus（13.74%,25/182）and Enterococcus Faecalis（10.44%,27/182）.The sensitivity rate of G+bacteria to tigecycline,vancomycin and linezolid is close to 100%.MRSA was 29.63%（8/27）MSSA was 70.37%（19/27）,No VRSA was found.Among the 92 strains of fungi detected,Candida Albicans（73.91%,8/92）were the main ones.Conclusion:1.The incidence of nosocomial infection rate after cardiovascular surgery has been decreasing in recent three years.2.The pathogens of nosocomial infection after cardiovascular surgery mainly come from sputum samples,followed by catheters and blood.The detection rate of sputum samples has been showing an upward trend in recent three years,the detection rate of catheters and blood samples have been decreasing in recent three years.3.Etiological characteristics of nosocomial infection after cardiovascular surgery:（1）G-bacteria are the main nosocomial infection after cardiovascular surgery,followed by G+bacteria and fungi.（2）G-bacteria are mainly Klebsiella Pneumoniae,Pseudomonas Aeruginosa, Enterobacter Cloacae and Acinetobacter Baumannii.The detection rate of G-bacteria increased in three years,the detection rate of Klebsiella Pneumoniae decreased and then increased in three years,that of Pseudomonas Aeruginosa increased and then decreased in three years,that of Enterobacter Cloacae increased in three years,and that of Acinetobacter Baumannii decreased and then increased in three years.CRPA and CRAB were detected,but no CRKP was found.（3）Staphylococcus was the main G+bacteria,MRSA was found,but VRSA was not found.（4）Candida is the dominant fungus.4.Nosocomial infection after cardiovascular surgery is seasonal,and the detection rate is higher in the second quarter.5.Nosocomial infection after cardiovascular surgery can be prevented and controlled,but there is still a long way to go,and we need to make unremitting efforts. |
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