创伤患者的医院感染危险因素研究

A study of dangerous factors about hospital infection on trauma patients

目的了解创伤患者医院感染的发生原因危险因素及条件。方法对临床１９９５～１９９７年１６４０例创伤患者进行了前瞻性和回顾性调查，并对其病原学标本进行常规细菌培养及真菌培养鉴定以及药敏试验，采用世界卫生组织ＷＨＯＮＴ４软件进行统计分析。结果调查１６４０例患者中医院感染率占１４．３３％，尤以肺部感染与伤口感染为主；其致病菌以革兰氏阴性杆菌占主导，其中假单胞菌属、铜绿假单胞菌、大肠埃希氏菌、肠杆菌属、不动杆菌属、金葡菌、凝固酶阴性葡萄球菌等为主。真菌感染占１１．１６％，主要为酶母样霉菌和念珠菌。这些菌株对临床常用抗生素都有不同程度耐药性，有些还呈多重耐药。结论发现引起创伤患者医院感染的主要危险因素除与宿主对感染的易感染性，包括年龄、原发疾病严重程度和免疫防御功能等有关外，另外医疗侵入性操作、抗生素不合理治疗、住院天数均与感染发生都有关，明显增加感染的机会。从而针对创伤患者医院感染的危险因素，提出了相应预防措施。

OBJECTIVE To understand the causes of dangerous factors about hospital infection on trauma patients was studied. METHODS Retrospective and prospective study were conducted on 1640 cases of trauma patients between 1995 and 1997. Bacteria and fungi culture and antibiotic sensitivity test were used for pathogen examination, and WHO WHONET4 software for statistical analysis. RESULTS Among 1640 cases, the rate of nosocomial infection was 14.33%, the main pathogens were such as Pseudomonas. P, aeruginosa, Escherichia coli, Enterobacter, Acinetobacter, Staphylococci aureus, Coag negative Staphylococci etc. The rate of Fungus infection was 11.6%, Candida albicans and Candida were the main pathogens among them. It resisted to antibiotics at different degrees, some showed multi-resistance. CONCLUSION The results suggest that except ages, the extent of severe disease and immunity, the main risk factors about nosocomial infection are related to medical invasion operation, unreasonable antibiotic therapy and treatment days in hospital. Precaution measurements were introduced to lower the infection rate of trauma patients on the basis of the dangerous factors submitted in this article.