系统性红斑狼疮患者医院获得性感染的危险因素调查研究

Risk factors of nosocomial infectios of patients with systemic lupus erythematosus

目的探讨系统性红斑狼疮(SLE)患者医院获得性感染的危险因素与预防措施。方法选取2017年8月~2019年2月武警特色医学中心收治100例SLE研究对象。根据其是否发生医院获得性感染分为感染组(32例)以及未感染组(68例)。分析SLE患者医院获得性感染病原菌分布,并探讨获得性感染的危险因素。结果100例SLE患者发生医院获得性感染的32例,感染率32.00%,其中以呼吸道及肺部感染为主,有11例,占感染患者中的34.38%;其次为消化道感染和泌尿生殖道感染,分别占25.00%和21.88%。32例感染患者共培养分离病原菌49株,其中革兰阴性菌23株(46.94%),以大肠埃希菌和肺炎克雷伯菌为主;革兰阳性菌15株(30.61%),以金黄色葡萄球菌为主;真菌11株(22.45%),以白假丝酵母菌为主。多因素logistic回归分析显示,住院时间≥25 d、器官损伤累及数≥2个、C-反应蛋白水平异常、血清白蛋白<35 g/L、白细胞<3.5×109/L以及使用免疫抑制剂为SLE患者医院获得性感染的独立危险因素(P<0.05)。结论SLE患者医院获得性感染发生率偏高,病原菌分布以革兰阴性菌为主;针对易感患者进行抗感染预防,可有效降低医院感染发生率。

Objective To explore the risk factors of nosocomial infections in patients with systemic lupus erythematosus(SLE).Methods Between August 2017 and February 2019,100 patients with SLE treated in Armed Police Characteristic Medical Center were enrolled and divided into the infection group(32 cases)and uninfected group(68 cases)based on the status of nosocomial infection.The distribution of pathogens in the infected group were analyzed and the risk factors for hospital acquired infections were explored.Results Among 100 patients with SLE,32 cases had acquired nosocomial infections with the infection rate of 32.00%.including 11(34.38%)cases with respiratory tract and lung infections,25%and 21.88%cases with digestive tract and urogenital tract infections.A total of 49 strains of pathogens were isolated,including 23(46.94%)strains of Gram-negative bacteria,15(30.61%)strains of Gram-positive bacteria and 11(22.45%)strains of fungi.Majority of the Gram-negative bacteria were E.coli and Klebsiella pneumoniae and Gram-positive bacteria were Staphylococcus aureus.Candida albicans was the most common fungus.Multivariate logistic regression analysis showed that length of hospital stay of 15 days and more,2 or more organs damaged,abnormal level of C-reactive protein,the serum albumin level of<35 g/L,leukocyte count of<3.5×10~9/L and the use of immunosuppressive drugs were independent risk factors for hospital acquired infections in patients with systemic lupus erythematosus(P<0.05).Conclusions The incidence rate of hospital acquired infection in patients with SLE is relatively high,and most of the pathogenic bacteria are Gram-negative ones.Anti-infection prevention targeted susceptible patients can effectively reduce the incidence of hospital acquired infection.