162例慢性乙型重型肝炎医院感染调查分析

Nosocomial infections and chronic severe hepatitis B: A clinical study of 162 patients

目的分析总结慢性乙型重型肝炎患者发生医院感染的特点,为加强医院感染的防控提供帮助。方法调查分析我院2008年1月至2011年10月收治的慢性乙型重型肝炎患者162例发生医院感染的情况。结果 162例慢性乙型重型肝炎患者中发生医院感染35例,医院感染率为21.6%。感染部位以腹腔感染和呼吸道感染最多,其次为肠道感染。病原菌以大肠埃希菌和肺炎克雷伯杆菌常见。医院感染主要发生在住院时间15～30 d,占72.09%。医院感染组治疗无效率(20%)显著高于非医院感染组(7.09%)(P<0.05)。结论慢性乙型重型肝炎医院感染发生率高,应积极治疗原发病,改善肝功能,严格遵守消毒隔离制度,加强医院感染的防控,从而提高生存率。

Objective To analyze and summarize the characteristics of nosocomial（hospital-acquired） infections experienced by chronic severe hepatitis B patients in order to strengthen prevention and control strategies.Methods Chronic severe hepatitis B patients treated in our hospital from January 2008 to October 2011 were retrospectively enrolled in the study.Cases of nosocomial infections were statistically analyzed by the Chi-squared test.Results Of the 162 patients with chronic severe hepatitis B,only 35 experienced nosocomial infections,yielding an infection rate of 21.6%.The most common infection sites were the abdominal cavity（41.86%）,the respiratory system（23.26%）,and the intestine（16.28%）.Escherichia coli and Klebsiella pneumoniae were the most commonly detected pathogens（29.63% and 18.52% of cases,respectively）.The rates of nosocomial infections were highest between days 15 to 30 of the hospital stay,accounting for 72.1%.The overall invalid rate and rate of death（expressed as a summed rate of ineffectivity） was significantly higher in the nosocomial infection group than in the non-nosocomial group（20.0% vs 7.1%,respectively;P0.05）.Conclusion The rate of nosocomial infections in chronic severe hepatitis B patients is high.Patients with chronic severe hepatitis B should be treated to resolve the primary disease,so as to improve liver function and general health;however,strict compliance with disinfection and hygeinic practices,as well as possible patient isolation,may decrease the incidence rate of nosocomial infections and improve survival in this patient population.