肝硬化患者院内感染的特点及影响因素分析

Clinical features and risk factors of nosocomial infection in patients with liver cirrhosis

目的全面了解肝硬化患者院内感染的特点、分析感染的部位、引起感染的病原体种类以及发生感染与肝功能Child-Pugh分级的关系,探讨引起院内感染的相关危险因素。方法将256例肝硬化患者分为感染组(88例)和非感染组(168例),对感染部位、病原体种类进行单因素分析;多因素分析采用非条件Logistic回归模型分析。结果肝硬化患者院内感染率为40.23%,共103例次;感染部位以腹腔感染为主(64例次,占62.14%);培养出真菌26株;G-杆菌12株;G+球菌7株和G+杆菌1株;院内感染的发生率与肝功能Child-Pugh积分有明显的相关关系;患者的年龄、住院时间、介入性操作、肝功能C级以上、并发症、血清白蛋白降低和不合理使用抗生素是肝硬化患者院内感染的确定因素。结论肝硬化患者院内感染的几率较高,感染部位以腹腔为常见;感染的菌种主要是真菌、G-杆菌和G+球菌,真菌感染有上升的趋势;院内感染的发生与肝功能的Child-Pugh积分密切相关,确定因素是年龄、住院时间、介入性操作、Child-Pugh积分C级以上、出现各种并发症、血清白蛋白降低和抗生素的滥用7种暴露因素。

Objective To find out the clinical features of nosocomial infection in patients with liver cirrhosis, the location of infection and the kind of pathogen. To analyze the relationship of infection with Child- pugh classification of liver function, and to summarize the risk factors of nosocomial infection. Methods 256 patients with liver cirrhosis were enrolled in this study and they were allocated to an infection group （88 cases） and a control group （168 cases）. The location of infection and the kind of pathogens were compared between the two groups. The risk factors of infection is studied by one - way analysis. Multiplicity analysis are made with unconditional logistic regression. Results ①The nce, ocomial infection rate was 40.23 % （103 cases） in patients with cirrhosis. The most frequent location of infection is abdominal cavity （64 cases, 62.14% ）. ②Pathogens are isolated as 26 strains of fungus, 12 strains of gram negative bacilli, 7 strains of gram positive cocci, 1 strain of gram positive bacilli. ③The nosocomial infection rate are found significntly correlated to Child - pugh score.④Multiplicity analysis： the risk factors of nce, ocomial infection in patients with cirrhosis are confirmed as age, length of stay in hospital, interventional procedures, liver function of Child B and C, development of complication, decreased level of serum albumin, abuse of antibiotics. Conclusion ① In this research, the nosocomial infection rate was high in patients with cirrhosis. The most frequent location of infection was abdominal cavity. The main antigens include fungus, gram negative bacilli and gram positive bacilli cocci. The infection of fungus are more and more frequent.②The nosocomial infection significantly correlated to Child - pugh score. ③By multiplicity analysis, seven exposures, including age, length of stay in hospitals,interventional procedures, a Child B and C level, development of complication, decreased serum albumin level, abuse of antibiotics, are confirmed as risk factors of the nosocomial infection in patients with cirrhosis.