南京市重症监护病房医院感染患者病原菌分布及感染因素分析

Analysis of pathogenic bacteria distribution and infection factors in patients with nosocomial infection in intensive care units in Nanjing

目的探讨重症监护病房住院患者医院感染及病原菌分布情况,并分析患者医院感染的影响因素。方法收集2019年1月至2021年12月南京市4家医院重症监护病房共2348例住院患者的性别、年龄等资料信息,并对3821份微生物样本进行细菌培养、鉴定,采用单、多因素分析方法对医院感染影响因素进行分析。结果共231例患者发生医院感染,感染率为9.84%。检出非重复病原菌382株,其中革兰阴性菌242株(63.55%),革兰阳性菌95株(24.87%),真菌45株(11.78%)。多因素Logistic回归分析结果显示,年龄<18岁(OR=4.775)、年龄60~75岁(OR=4.426)、病情严重程度≥4分(OR=4.818)、重症监护病房入住时间≥15 d(OR=6.134)、中心静脉插管(OR=6.420)、气管插管(OR=3.264)、泌尿道插管(OR=5.711)、抗菌药物使用≥2种(OR=4.748)、手术(OR=7.843)、合并糖尿病(OR=45.901)是重症监护病房住院患者医院感染的危险因素。结论重症监护病房住院患者医院感染以革兰阴性菌为主,与年龄、病情严重程度、住院时间、中心静脉插管、气管插管等因素密切相关。医护人员可通过坚持无菌操作、环境消毒与净化、合理使用抗菌药物等措施预防和控制医院感染。

Objective To explore nosocomial infection and the distribution of pathogenic bacteria in intensive care unit(ICU)patients,and analyze the influencing factors of nosocomial infection in patients.Methods From January 2019 to December 2021,2348 patients hospitalized in the ICU of four hospitals in Nanjing were selected.Clinical data such as gender and age of the patients were collected,and 3821 microbiological samples were cultured and identified.The factors affecting nosocomial infection were analyzed by univariate and multivariate analysis methods.Results A total of 231 patients were infected in the hospital,the infection rate was 9.84%.A total of 382 strains of non-repetitive pathogenic bacteria were detected,including 242 gram-negative bacteria(63.55%),95 gram-positive bacteria(24.87%),and 45 fungi(11.78%).Multivariate Logistic regression analysis showed that age<18 years old(OR=4.775),age 60-75 years old(OR=4.426),severity of disease≥4 points(OR=4.818),admission time in ICU≥15 days(OR=6.134),central venous intubation(OR=6.420),tracheal intubation(OR=3.264),urinary intubation(OR=5.711),use of≥2 antibiotics(OR=4.748),surgery(OR=7.843),and complicated with diabetes mellitus(OR=45.901)were risk factors for nosocomial infection in ICU patients.Conclusions The nosocomial infection of ICU patients is mainly caused by gram-negative bacteria,which is closely related to age,the severity of the disease,length of stay,central venous intubation,tracheal intubation,and other factors.Medical staff can prevent and control nosocomial infection by adhering to aseptic operation,environmental disinfection and purification,rational use of antibiotics,and other measures.