medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2019-1-15(390)-31-35medalphabet-1307Research ArticleСтатьиГрамотрицательные госпитальные патогены в риске развития тяжелых бактериальных инфекцийGram-negative hospital pathogens at risk of severe bacterial infectionГабриэлянН. И.GabrielyanN. I.

д. м. н., зав. отделом, отдел эндотоксикозов и гнойно-септических осложнений

г. Москва

Moscow

ШарапченкоС. О.SharapchenkoS. O.

лаборант-исследователь, отдел эндотоксикозов и гнойно-септических осложнений

г. Москва

Moscow

ДрабкинаИ. В.DrabkinaI. V.

врач-бактериолог лаборатории бактериологии, отдел эндотоксикозов и гнойно-септических осложнений

г. Москва

Moscow

КубановаМ. Х.KubanovaM. Kh.

врач-бактериолог лаборатории бактериологии, отдел эндотоксикозов и гнойно-септических осложнений

г. Москва

Moscow

КрупениоТ. В. KrupenioT. V.

врач-бактериолог лаборатории бактериологии, отдел эндотоксикозов и гнойно-септических осложнений

г. Москва

Moscow

РомашкинаЛ. Ю.RomashkinaL. Yu.

лаборант-исследователь, отдел эндотоксикозов и гнойно-септических осложнений

г. Москва

Moscow

СафоноваТ. Б.SafonovaT. B.

к. м. н., доцент кафедры микробиологии

г. Москва

Moscow

ПетрухинаМ. И.PetrukhinaM. I.

к. м. н., доцент кафедры эпидемиологии

г. Москва

Moscow

СтоляроваЛ. Г.StolyarovaL. G.

к. б. н., доцент кафедры микробиологии

г. Москва

Moscow

ФГБУ «Национальный медицинский исследовательский центр трансплантологии и искусственных органов имени академика В. И. Шумакова» Минздрава РоссииРоссияNational Medical Research Center of Transplantology and Artificial Organs named after Academician V.I. ShumakovRussian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy of Continuing Professional Education of the Ministry of Health of RussiaRussian Federation201929112019115Обозрение3135Copyright © Габриэлян Н.И., Шарапченко С.О., Драбкина И.В., Кубанова М.Х., Крупенио Т.В., Ромашкина Л.Ю., Сафонова Т.Б., Петрухина М.И., Столярова Л.Г., 20192019Габриэлян Н.И., Шарапченко С.О., Драбкина И.В., Кубанова М.Х., Крупенио Т.В., Ромашкина Л.Ю., Сафонова Т.Б., Петрухина М.И., Столярова Л.Г.Gabrielyan N.I., Sharapchenko S.O., Drabkina I.V., Kubanova M.K., Krupenio T.V., Romashkina L.Y., Safonova T.B., Petrukhina M.I., Stolyarova L.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1307

Внутрибольничные инфекции (ВБИ) остаются актуальной проблемой современной медицины. Наряду с бактериальной инфекцией кровотока (БИК) особую опасность представляют вентиляционно-зависимые легочные инфекции (ВЗЛИ), основными очагами которых по прежнему остаются отделения реанимации и интенсивной терапии (ОРИТ).

Цель исследования

Цель исследования. Оценка распространения бактериальных инфекций в ОРИТ за пятилетний период. Анализ тяжести течения послеоперационных осложнений в зависимости от локализации первичного очага инфекции.

Материалы и методы

Материалы и методы. Проведен ретроспективный анализ частоты и формы развития БИК и ВЗЛИ у пациентов, прооперированных в условиях искусственного кровообращения (ИК) с 2013 по 2017 год.

Результаты

Результаты. Высеваемость из крови в отделениях колебалась в пределах 8,0–9,8 %; в ОРИТ этот показатель был достоверно выше и составил 17–24 % (р < 0,01). Летальность, ассоциированная с грамотрицательными возбудителями БИК и ВЗЛИ, достоверно выше по сравнению с грамположительными микроорганизмами р < 0,001. Наиболее часто встречающиеся представители грамотрицательной флоры — Acinetobacter spp. и Klebsiella spp. Анализ первичности обнаружения патогена показал, что в 73,6 % случаев сочетанной формы инфекции областью ее первоначальной локализации выступает трахея.

Заключение

Заключение. Риск развития бактериальных осложнений в раннем послеоперационном периоде ассоциирован с представителями грамотрицательной флоры — Acinetobacter spp. и Klebsiella spp. Постоянный бактериологический мониторинг пациентов на предмет ВЗЛИ выступает эффективным прогностическим инструментом формирования группы риска среди пациентов ОРИТ.

Background

Background. Nosocomial infections remain an urgent problem of modern medicine. Along with bacterial infection of the bloodstream a special danger is posed by ventilation-dependent lung infection (VDLI), the main source which are still at the intensive care unit (ICU).

Objectives

Objectives. Assessment of the spread of bacterial infections in ICU over a five-year period. Analysis of the severity of postoperative complications depending on the infection location.

Methods

Methods. A retrospective analysis of the frequency and form of blood flow and ventilation-dependent lung infection in patients, operated under cardiopulmonary bypass in the years 2013–2017.

Results

Results. The rate of blood contamination in the departments ranged from 8.0 to 9.8 %; against the ICU — from 17 to 24 % (p < 0,01). Gram-negative associated mortality was significantly higher than gram-positive (p < 0.001). Acinetobacter spp. and Klebsiella spp. are the most common agents. Analysis of the primary detection of the pathogen showed that in 73.6 % of cases, the trachea is the area of the initial localization of combined-form infection.

Conclusions

Conclusions. The risk of bacterial complications in the early postoperative period is associated with gram-negative pathogen s (Acinetobacter spp. and Klebsiella spp.). Constant bacteriological monitoring in ICU is an effective prognostic tool of blood flow and ventilation-dependent lung infection. 

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The authors declare that there are no conflicts of interest present.