Analysis Of Nosocomial Infection In Cardiac Surgery And Its Influencing Factors

Objective:Nosocomial infection is one of the important risk factors that affect medical quality and threaten the health of patients and medical staff.This study investigated the situation of nosocomial infection after cardiac surgery retrospectively,to understand the current situation and influencing factors of postoperative infection,and to provide scientific basis for prevention and control of nosocomial infection.Methods :A retrospective case-control study was conducted on 1084 patients who were hospitalized in the Department of cardiac surgery of a Class A tertiary hospital and underwent cardiac and macrovascular surgery from August 1,2017 to July 31,2020,including 734 males and 350 females.Perioperative data were collected and the incidence of infection was recorded.(1)patient’s own factors such as gender,age,BMI,previous history,etc.;(2)operation related factors such as hospital stay,operation mode,operation time,operation times,perioperative blood transfusion,etc.;(3)invasive operations such as endotracheal intubation,venous intubation,urinary catheter intubation and other suspicious risk factors related to nosocomial infection were analyzed.T-test was used to compare two sample data,and chi square test was used to compare count data.The related factors of postoperative infection were analyzed by univariate analysis,and the factors with statistically significant difference were analyzed by multivariate unconditional logistic regression.The multilayer perceptron of neural network module is used to analyze the data by neural network.The pathogenic bacteria were isolated and cultured from stool samples,sputum samples,wound secretion samples,urine and blood,fungi and bacteria were detected,and drug sensitivity tests were carried out.Results:1.Basic information of patients A total of 1084 patients who were hospitalized in the Department of Cardiology and underwent cardiac and macrovascular surgery in a hospital from August 1,2017 to July 31,2020 were included in this study,including 67.71% of male patients,32.29% of female patients,32.92% of patients under the age of 60 and 67.08% of patients over the age of 60.The age of the patients ranged from 18 to 89 years,with an average age of 62.97 ± 11.023 years.2.Clinical information of patients The BMI of patients ranged from 22 to 28,and overweight and obese patients accounted for 63.1%.The length of stay ranged from 0 days to 201 days,with a positive skew distribution,with a median of 18 days.9.23% of patients were hospitalized within 7 days,and 90.77% of patients were hospitalized more than 7 days.The number of operations performed by patients ranged from 1 to 7,with a positive skew distribution.Patients with more than 2 operations accounted for 35.7%.The single operation time of patients was mostly between 3-5h,accounting for 41%.The single operation time within 3 hours accounted for 32.2%,and more than 5h accounted for 26.8%.Non cardiopulmonary bypass was the main surgical method,accounting for 65.3%.The major past history was hypertension and diabetes,accounting for 61.6% and 27.5% of the total number of patients.3.Nosocomial infection of patients In this study,the incidence of nosocomial infection was 22.60%.Among the patients with nosocomial infection,71.84% were male and28.16% were female.Patients younger than 60 years old accounted for 31.84%,and patients aged 60 and over accounted for 68.16%.All nosocomial infections occurred within 20 days after operation,accounting for 44.6% of all infections within 5 days after operation,and85.88% of the infections occurred in the first 10 days.Patients with postoperative infection were involved in 1-3 parts,mainly in the blood system,respiratory system and urinary system.Gram positive bacteria accounted for 28.4%,mainly Staphylococcus epidermidis and Staphylococcus aureus;Gram negative bacteria accounted for 55.3%,mainly Pseudomonas aeruginosa and Acinetobacter baumannii;Fungi accounted for 16.3%,mainly Candida.4.Analysis of infection factors after cardiac surgery Univariate analysis showed that operation time,operation times,hospitalization time,operation mode,intravenous intubation,tracheal intubation,catheter intubation and blood transfusion history were the risk factors of postoperative infection.Multivariate Logistic regression analysis showed that gender,age,BMI,history of hypertension,history of diabetes,history of smoking and other factors had nothing to do with the occurrence of nosocomial infection.Intravenous intubation and blood transfusion were the risk factors of nosocomial infection.The hospital stay of more than 7days,more than 2 operations and more than 5 hours of operation would all increase the risk of nosocomial infection.5.Neural network model The neural network model had a strong ability to distinguish samples,and the area under ROC curve was 0.955.Conclusions:The nosocomial infection rate after cardiac surgery is 22.60%,mostly in the respiratory system,urinary system and blood system.The pathogens are mainly Gram-negative bacteria.Antibiotics should be used reasonably and correctly to actively prevent the emergence of drug-resistant bacteria and the infection caused by opportunistic pathogens.Endotracheal intubation,intravenous intubation,indwelling catheter,blood transfusion and cardiopulmonary bypass are important factors leading to nosocomial infection.Long-term operation,multiple operations and long-term hospitalization can increase the risk of nosocomial infection.