医院败血症相关危险因素及耐药性分析

Analysis of risk factors and drug-resistant associated with nosocomial bacteremia

目的探讨医院败血症的危险因素，减少医源性因素所致败血症风险。方法收集2006年1月至2009年12月期间在本院住院的菌血症患者资料。根据医院感染的定义将这些患者分为医院败血症组（83例）和社区获得性败血症组（119例），对2组临床资料进行统计，对筛选出的可能危险因素进行多因素logistic回归分析。结果与社区获得性败血症相比较，医院败血症患者患恶性肿瘤的比例较高（21／83VS12／119，x2：8．2846，P〈0．01），使用静脉留置导管比例高（28／83VS3／119，）（。=36．67，P〈0．01），接受手术者比例高（37／83VS0／119，x2=68．226，P〈0．01），既往使用抗生素比例较高（78／83VS10／119，x2=173．5657，P〈0．01）。多因素logistic回归分析示：伴有糖尿病者（P〈0．001，OR=4．821）、患恶性肿瘤者（P〈0．05，OR=3．186）、有静脉留置导管者（P〈0．05，OR=2．135）及既往不当抗生素治疗者（P〈0．05，OR=2．135）更易患医院败血症。且医院败血症感染细菌耐药率更高。结论医院内败血症严重威胁人类健康，糖尿病、恶性肿瘤、静脉留置导管及抗生素不当使用是相关危险因素。且医院内败血症感染细菌更具耐药性。

Objective To investigate the risk factors for nosocomial bacteremia and decrease the prevalence of nosocomial bacteremia. Methods We collected the data of baeteremia patients in our hospi- tal from January, 2006 to December, 2009. According to the criterion of nosocomial infection, the patients were divided into nosocomial bacteremia group （83） and community-onset bacteremia group （ 119 ）. The influence of a series of variables on the development on both types of bacteremia was analyzed by Student＇s t test and X2 test. The risk factors were performed Using multivariate logistic regression. Results Compared to that of community-onset bacteremia group, the proportion of malignancy （21/83 vs 12/119, X2 = 8. 2846, P 〈 0. 01 ）, venous catheter （28/83 vs 3/119, X2 = 36. 67, P 〈 0.01 ）, diabetes （ 37/83 vs 0/ 119, x2 = 68. 226, P 〈 0.05）, surgical operation （37/83 vs 0/119, x2 = 68. 226, P 〈 0. 01 ）, previous antibiotics（78/83 vs 10/119, X2 = 173. 5657, P 〈 0. 01 ） in nosocomial bacteremia group were higher. Muhivariable logistic regression analysis showed that only 4 factors were significantly and independently responsible for nosoeomial baeteremia, They were malignancy （ P 〈0. 05, OR = 3. 186 ） , diabetes （ P 〈 0. 001, OR =4. 821 ） , venous catheter（ P 〈 0. 05, OR = 2. 135）, previous antibiotics （ P 〈 0. 05, OR = 2. 135 ）. The bacteria in nosoeomial bacteremia group showed more ability to resist to antibiotics. Conclusions We should pay more attention to the patients with diabetes or malignancy or venous catheter or previous treated with antibiotics. These patients have more chances to develop to nosoeomial bacteremia and infect by the drug-resistant bacteria.