郑州市某医院下呼吸道医院感染率及其危险因素的长期趋势

Secular trend of nosocomial pneumonia in an university hospital in Zhengzhou

目的研究下呼吸道医院感染率及危险因素暴露率的时间趋势,评价医院感染监测效果。方法对河南郑州市某省级医院1993至2000年的126665例住院患者的下呼吸道医院感染率进行前瞻性监测,应用病例对照研究和logistic回归分析方法,筛选下呼吸道医院感染的独立危险因素,并计算这些危险因素暴露率的时间趋势。结果下呼吸道医院感染率由1993年的1.20%降到2000年的0.60%;logistic回归分析结果显示下呼吸道医院感染的独立危险因素为免疫抑制剂治疗(OR=2.72)、化疗(OR=2.17)、肿瘤患者(OR=1.45)、合并慢性阻塞性肺疾病(OR=1.88)、住ICU病房(OR=3.18)、住院期间发生昏迷(OR=3.26)、气管切开(OR=14.95)、接受透析治疗(OR=5.12)和骨/腰穿刺(OR=1.82)。除慢性阻塞性肺疾病和骨/腰穿刺的暴露率呈下降趋势外,其他7个危险因素的暴露率及综合危险因素暴露率的时间趋势无显著变化。结论在大多数危险因素暴露率的时间趋势没有明显变化的情况下,医院感染的监测可降低下呼吸道医院感染的发生率。

Objective To investigate the secular trend of infection rate, risk factor exposure rates for nosocomial pneumonia （NP）, and to evaluate the nosocomial infection surveillance and control programs efficacy in an university hospital from 1993 to 2000. Methods All 126 665 hospitalized patients from 1993 to 2000 were studied for NP. The independent risk factors for NP were analyzed by using case-control study method and logistic regression technique. The time-specific rates for NP and risk factor exposure were calculated annually. Results The infection rates for NP were decreased by 50% from 1.20% in 1993 to 0. 60% in 2000. The logistic regression analysis sbowed that the independent risk factors for NP were immunosuppressive therapy （ OR = 2.72 ）, chemotherapy （ OR = 2. 17）, cancer （ OR = 1.45 ）, chronic obstructive pulmonary disease （ COPD, OR = 1.88）, ICU （ OR = 3.18 ）, coma （ OR = 3.26 ）, tracheotomy （OR = 14. 95）, hemodialysis （ OR = 5. 12）, bone or lumbar puncture （ OR = 1.82）. The time-trends for exposure rates of COPD and bone or lumbar puncture were slightly decreased, however those for the others and the synthetic risk factors were not changed significantly. Conclusion The infection rates for NP were significantly decreased in the case of no change for exposure rates of risk factors for NP, this suggests that the nosocomial infection surveillance and control programs were effective for lowering infection rate for NP in this hospital.