神经内科患者医院感染危险因素的调查分析

Investigation and analysis of risk factors of nosocomial infections in patients of neurology department

目的分析神经内科患者医院感染的危险因素,为减少医院感染的发生提供依据。方法回顾性分析神经内科住院治疗的600例患者临床资料,其中发生医院感染的64例患者为感染组,未发生感染的536例患者为非感染组;logistic回归分析其医院感染的危险因素。结果发生医院感染64例,感染率为10.67%,其发生率最高的为脑梗死占11.71%;最常见的感染部位为下呼吸道占32.81%,其次为上呼吸道感染占26.56%;共培养出病原菌53株,革兰阴性菌53株占52.48%,其中铜绿假单胞菌为最多见占14.85%,革兰阳性菌31株占30.69%,以金黄色葡萄球菌为最多见占11.88%,真菌17株占16.83%,以白色假丝酵母菌为主占12.87%;年龄>60岁、合并糖尿病、有慢性基础疾病病史、有接受侵入性的诊断和治疗措施、有意识障碍以及住院>14d为神经内科住院患者医院感染的危险因素。结论稳定患者血糖水平、减少及规范侵入性诊疗操作、合理应用抗菌药物、缩短患者住院时间、提高患者免疫功可减少医院感染发生,提高临床疗效及患者生存质量。

OBJECTIVE To analyze the risk factors of nosocomial infections in the patients of neurology department so as to reduce the incidence of nosocomial infections. METHODS The clinical data of 600 patients who were trea- ted in the neurology department were retrospectively analyzed, totally 64 cases of patients with nosocomial infec- tions were set as the infection group, and 536 cases of patients without infections were set as the non-infection group, then the logistic regression analysis was performed for the related risk factors of nosocomial infections. RESULTS The nosocomial infections occurred in 64 cases with the incidence rate of 10.67 %, and the infection rate was the highest （11.71%） in the patients with cerebral infarction. The lower respiratory tract was the most com- mon infection site, accounting for 32. 81%, followed by the upper respiratory tract （26. 56%）. A total of 53 strains of pathogens were isolated, there were 53 （52.48%） strains of gram-negative bacteria, among which the Pseudomonas aeruginosa was predominant, accounting for 14.85%, and there were 31 （30.69%） strains of gram- positive bacteria, among which the Staphylococcus aureus was the most common species, accounting for 11.88 %, and there were 17 （16.83%） strains of fungi, among which the Candida albicans was predominant, accounting for 12.87%. More than 60 years of age, complication of diabetes, history of chronic underlying disease, invasive diagnostic and therapeutic measure, disturbance of consciousness, and length of hospital stay more than 14 days were the risk factors of nosocomial infections in the hospitalized patients of the neurology department. CONCLUSION Controlling the blood glucose levels, reducing the inva sive diagnostic and treatment measures, reducing the hospitalization duration, and improving the immunity of the patients can reduce the incidence of noso- comial infections and improve the clinical therapeutic effect as well as the survival quality.