急性心肌梗死患者医院感染的特点及相关危险因素分析

Characteristics and related risk factors for nosocomial infections in patients with acute myocardial infarction

目的探讨急性心肌梗死患者医院感染的特点及相关危险因素,以期为防治急性心肌梗死患者医院感染提供参考。方法回顾性分析医院2002年7月-2012年6月心内科收治的462例急性心肌梗死患者临床资料,分析医院感染发生情况及其相关危险因素。结果 462例急性心肌梗死患者医院感染率14.94%,感染部位以呼吸道为主,38例占55.07%,其余依次为泌尿道、胃肠道、口腔、穿刺部位、血液,分别占14.49%、11.59%、8.70%、8.70%、1.45%;共检出病原菌57株,其中革兰阴性菌42株占73.68%,革兰阳性菌13株占22.81%,真菌2株占3.51%;患者年龄、合并高血压、心力衰竭、心律失常、侵入性操作、使用抗菌药物、大面积梗死、住院天数是引起急性心肌梗死患者发生医院感染的相关危险因素(P<0.01)。结论急性心肌梗死患者医院感染率高,感染部位以呼吸道感染多见,感染病原菌以革兰阴性菌为主,引起医院感染的危险因素较为复杂,应针对相关危险因素进行合理干预以降低医院感染的发生。

OBJECTIVE To explore the characteristics and related risk factors for nosocomial infections in the patients with acute myocardial infarction so as to provide guidance for prevention and treatment of the nosocomial infections in the patients with acute myocardial infarction.METHODS The clinical data of 462cases of acute myocardial infarction who were treated in the department of cardiology from Jul 2002 to Jun 2012 were retrospectively analyzed,then the incidence of nosocomial infections and the related risk factors were observed.RESULTS Of totally 462cases of acute myocardial infarction,the incidence of the nosocomial infections was 14.94%,55.07%（38cases）of the cases were respiratory tract infections,followed by the urinary tract infections（14.49%）,the gastrointestinal tract infections（11.59%）,the oral infections（8.70%）,the puncture site infections（8.70%）,and the bloodstream infections（1.45%）.A total of 57strains of pathogens have been isolated,including 42（73.68%） strains of gram-negative bacteria,13（22.81%）strains of gram-positive bacteria,2（3.51%）strains of fungi.The risk factors associated with the nosocomial infections in the acute myocardial infarction patients included the age, complication of hypertension,heart failure,arrhythmia,invasive operation,use of antibiotics,large area of infarction,and length of hospital stay（P0.01）.CONCLUSION The incidence of the nosocomial infections is high in the patients with acute myocardial infarction,the respiratory tract is the most common infection site;the gramnegative bacteria are predominant pathogens causing the infections;the risk factors for the nosocomial infections are so complicated that the reasonable interventions should be taken to reduce the incidence of the nosocomial infections.