免疫受损者医院感染调查与危险因素分析

Investigation on nosocomial infection in immunosuppressive patients and analysis on risk factors

目的了解接受免疫抑制剂治疗患者医院感染的特点与危险因素。方法采用回顾性调查方式,对2003年1月—2004年6月在某院接受免疫抑制剂治疗患者的免疫抑制治疗天数、感染前使用抗菌药物与否等因素与医院感染进行调查分析。结果2 247例患者,发生医院感染的人次和例次率分别为9.08%、11.79%,其中以急性白血病患者医院感染率最高(22.50%),其次为系统性红斑狼疮患者(16.54%);医院感染部位以下呼吸道为主(24.53%),其次为口腔(18.49%),发生的时间主要在接受免疫抑制剂治疗后(占58.11%);医院感染发生之前的住院天数、抗菌药物和免疫抑制剂使用天数≥7d与<7d者比较,及外周血白细胞≤1.0×109/L或≥20.0×109/L时,医院感染率明显增高。结论接受免疫抑制剂治疗者基础疾病不同,医院感染发生率不同;医院感染的发生与患者住院天数、抗菌药物和免疫抑制剂使用天数以及血白细胞的质和量有关,且医院感染部位有其自身特点。

Objective To investigate the characteristics of nosocomial infection （NI） in immunosuppressive patients and risk factors. Methods The duration of immunosuppressive and antimicrobial agents application and the occurrence of NI in patients who were hospitalized from January,2003 to June,2004 were investigated retrospectively. Results Among 2 247 patients, the occurrence of NI and case infection rate was 9. 08% and 11.79% respectively, NI rate was the highest in patients with acute leukemia（22.50%）, the next was in patients with lupus erythematosis（16. 54%）; the main NI site was lower respiratory tract （24. 53%）, the next was oral cavity （18. 49%）, most NI were developed after patients had received immunosuppressive agents（58. 11%）; NI increased significantly in pa- tients whose hospitalization days, antimicrobial and immunosuppressive agents application time ≥7 days and whose peripheral white blood cell count ≤1. 0 × 10^9/L or ≥20. 0 × 10^9/L. Conclusion Patients who received immunosuppressive agents had different underlying diseases and different NI rates, the occurrence of NI is related with patients＇ hospitalization days, antimicrobial and immunosuppressive agents application time and characteristics of white blood cells.