重症手足口病医院感染危险因素分析

Risk factors for nosocomial infections in patients with severe hand-foot-mouth diseases

目的探讨重症手足口病医院感染的危险因素,为临床诊治提供参考依据。方法回顾性分析2010年河北省儿童医院ICU重症手足口病患儿,按诊断将其分为感染组及非感染组,比较两组患儿在性别、年龄、住院时间、使用呼吸机、留置胃管、并发症、抗菌药物联合应用、激素应用等方面的差异性,应用单因素和多因素非条件logistics回归分析方法,研究医院感染危险因素。结果 2010年1-12月医院共收治手足口病重症患儿408例,感染组21例、非感染组387例,单因素分析年龄、住院时间、使用呼吸机、留置胃管、并发症≥2种、抗菌药联合应用≥2种及激素的使用,差异有统计学意义(P<0.05),引入多因素非条件logistic回归模型,进行多因素回归分析,住院时间、使用呼吸机、留置胃管、抗菌药物应用≥2种、并发症≥2种是医院感染的危险因素;而呼吸机的使用是导致医院感染的主要危险因素。结论针对重症手足口病的高危因素,采取综合性防治措施,降低医院感染率。

BJECTIVE To explore the risk factors for nosocomial infections in the patients with severe hand-foot- mouth diseases （HFMD） so as to provide basis for the clinical treatment. METHODS Retrospective analysis of severe HFMD in children in the ICU of Hebei province Children＇s Hospital in 2010 was performed, those children were divided into the infection group and non-infection group according to the diagnostic criteria, the differences in the gender, age, hospitalization duration, use of respirator, indwelling gastric tube, complications, combined use of antibiotics,and the application of hormone of the children in the two groups were compared, the risk factors for nosocomiai infections were explored by using univariate and multivariate non-conditional logistics regression a nalysis method. RESULTS Totally 431 children with HFMD were treated in hospital from Jan to Dec 2010, including 21 cases in the infection group and 387 cases in the non-infection group; the univariate analysis showed that the differences in the age, hospital stay, the use of respirator, indwelling gastric tube, complications（≥2）, combined use of antibiotics （≥ 2） and the application of hormone were statistically significant （P 〈 0. 05） ; multivariate regression analysis performed by multivariate non-conditional logistic regression model demonstrated that the hospital stay, use of respirator, indwelling gastric tube, complications（≥2）, and the combined use of antibacterial drugs（≥2） were the risk factors for nosocomial infections~ the use of respirator was predominant risk factor for nosocomial infections. CONCLUSION Comprehensive prevention measures should be taken to reduce the nosocomial infections in view of high risk factors for severe HFMD.