神经外科医院感染相关危险因素分析

Risk factors for nosocomial infections in department of neurosurgery

目的分析神经外科医院感染患者的病情、流行病学特征及导致感染发生的危险因素,为神经外科控制医院感染提供临床参考依据。方法回顾性分析2012年1月-2013年7月医院神经外科1 732例住院患者临床资料,对医院感染发生率及感染部位、医院感染病原菌分布和药敏试验等进行分析,同时对神经外科医院感染的危险因素进行统计处理,对单因素进行χ2检验,多因素进行logistic回归分析,筛选出导致患者发生医院感染的危险因素。结果 1 732例住院患者中发生医院感染157例,感染率9.1%;感染部位以下呼吸道为主占41.4%;年龄、住院天数、手术类型等是诱发神经外科患者医院感染的危险因素(P<0.05),经logistic回归分析,年龄、手术类型、开颅手术为独立危险因素(P<0.01);157例患者标本培养中共分离出病原菌172株,其中革兰阴性菌119株占69.2%,革兰阳性菌31株占18.0%,真菌22株占12.8%;鲍氏不动杆菌和大肠埃希菌对氨苄西林耐药率均为100.0%,肺炎克雷伯菌和大肠埃希菌对环丙沙星的耐药率均为100.0%,鲍氏不动杆菌和大肠埃希菌对亚胺培南的耐药率为0。结论神经外科患者易发生医院感染,临床中应重点关注年龄、住院天数、手术类型、留置尿管、开颅手术等神经外科医院感染发生的危险因素,分析患者病原菌,根据药敏试验结果针对性的合理应用抗菌药物,努力降低神经外科医院感染发生率。

OBJECTIVE To analyze the condition and epidemiological characteristics of patients with nosocomial infections in department of neurosurgery and explore risk factors for the infections so as to provide guidance for control of the nosocomial infections. METHODS The clinical data of 1732 patients who were hospitalized the department of neurosurgery from Jan 2012 to Jul 2013 were retrospectively analyzed, then the incidence of nosocomial infections, infection sites, distribution of pathogens, and result of drug susceptibility testing were observed, the risk factors for the nosocomial infections were statistically analyzed, the chi-square test was conducted for univariate analysis, the multivariate logistic regression analysis was performed to screen out the risk factors for the nosocomial infections. RESULTS Of the 1732 hospitalized patients investigated, the nosocomial infections occurred in 157 cases with the infection rate of 9.1 , among which the cases of lower respiratory tract infections accounted for 41. 4. The age, hospitalization duration, and type of surgery were the predisposing factors for the nosocomial infections（P〈0. 05）; the logistic regression analysis showed that the age, type of surgery, and craniotomy were the independent risk factors（P〈0. 01）. A total of 172 strains of pathogens have been isolated from the specimens culture of 157 patients, including 119 （69. 2%） strains of gram-negative bacteria, 31 （18.0） strains of gram-positive bacteria, and 22 （12.8） strains of fungi. The drug resistance rates of the Acinetobacter baumannii and Escherichia coli to ampicillin were 100.0, the drug resistance rates of the Klebsiella pneumoniae and E. coli to ciprofloxaxin were 100.0, and the drug resistance rates of the A. bau- mannii and E. coli to imipenem were 0. CONCLUSION The patients of department of neurosurgery are at high risk for nosocomial infections; it is necessary for the hospital to focus on such risk factors as the age, hospitalization duration, type of surgery, catheter indwelling, and craniotomy; the distribution of pathogens shouldbe analyzed and the antibiotics should be reasonably used based on the drug susceptibility testing so as to reduce the incidence of nosocomial infections in the department of neurosurgery