医院获得性下呼吸道感染病原菌监测与危险因素分析

Monitoring of pathogenic bacteria causing hospital-acquired lower respiratory tract infection and analysis of risk factors

目的探讨分析医院获得性下呼吸道感染的病原菌分布及相关的危险因素,为控制医院感染提供实验室依据。方法回顾性分析2009年4月-2012年10月168例发生医院获得性下呼吸道感染患者的临床资料,同时选取168例同期在医院接受治疗未发生下呼吸道感染的患者作为对照组,比较两组患者的临床资料,分析医院获得性下呼吸道感染的病原菌分布与危险因素,采用SPSS16.0软件对数据进行统计分析。结果感染组168例患者均获得细菌学检查阳性结果,其中革兰阳性菌41株占24.4%,革兰阴性菌103株占61.3%,真菌24株占14.3%;感染组与对照组年龄、住院时间、抗菌药物使用时间、机械通气、应用糖皮质激素、应用碳青霉烯类药物、合并慢性阻塞性肺疾病(COPD)及糖尿病比较,差异有统计学意义(P<0.05);住院时间及抗菌药物使用时间感染组分别为(36.2±24.7)、(18.4±9.6)d,对照组分别为(19.4±15.3)、(11.5±5.7)d,两组比较差异有统计学意义,多因素logistic回归分析结果显示,年龄、住院时间、抗菌药物使用时间、机械通气时间、合并COPD及合并糖尿病与医院获得性下呼吸道感染的危险因素(P<0.05)。结论医院获得性下呼吸道感染的病原菌以革兰阴性菌较为多见,医务人员应合理使用抗菌药物,缩短患者的住院时间,控制基础疾病的发展以减少感染的发生。

OBJECTIVE To study the distribution of pathogenic bacteria causing hospital-acquired lower respiratory tract infection and the risk factors in order to pronide the laboratory reforence for inpetion control. METHODS The clinical data of 168 patients with hospital-acquired lower respiratory tract infection in our hospital from Apr. 2009 to Oct. 2012 were retrospectively analyzed. 168 patients without hospital-acquired lower respiratory tract infections were selected as the control group. The clinical data of the two groups were compared, then the distribution of pathogenic bacteria causing hospital-acquired lower respiratory tract infection and the risk factors were analyzed. RESULTS The balteriad tests for the 168 patients in the infected group were all positive. A total of 168 strains were isolated, including gram-positive bacteria （41, 21. 4 %）, gram-negative bacteria （103, 61. 3 %） and fungi （24,14.3%）. The difference between the infected group and the control group in the factors, including age, hospitalization time, using time of antibiotics, mechanical ventilation, use of glucocorticoids , use of carbapenems, combination of chronic obstructive pulmonary disease （COPD） and diabetes, was statistically significant （P 〈 0.05）. The hospital time and the using time of antibiotics in the the intecred youp were （36. 2±24. 7） d and （18.4 ±9. 6） d, The hospital tine and the usry tina of antibiotics were （19. 4±15. 3）d and （11. 5±5. 7）d. statistical differences was significant. The of multivariate logistic regression analysis showed that age, hospitalization time, using time of antibiotics, mechanical ventilation, combination of COPD and diabetes were closely related with hospital-acquired lower respiratory tract infections, which were risk factors. CONCLUSION Gram-negative bacteria are common in hospital-acquired lower respiratory tract infection. The medical staff should use the antibiotics rationally, shorten the hospital stay, control the development of the underlying disease so that the incidence of infections could be reduced.