神经外科重症监护病房医院感染的临床调查

Clinical investigation of hospital infections in neurosurgical intensive care unit

目的通过调查分析神经外科重症监护病房(NICU)医院感染发生情况、感染部位病原菌的构成及感染影响因素,以寻求有效的预防措施。方法通过自制调查表收集贵州省铜仁医院2008年1月至2010年5月362例NICU患者的临床资料,包括患者年龄、感染部位、感染诱发因素、病原菌种类及其耐药性、可能的影响因素等并作分析。结果医院感染发生率为18.5%,8.2例/1 000床日,高于同期医院其他科室的感染率;发生医院感染的主要疾病为中枢神经系统炎症和医院获得性肺炎,分别为58.2%和34.3%;共检出病原菌220株,其中革兰阴性杆菌103株(46.8%),革兰阳性球菌96株(43.6%),真菌21株(9.5%)。金葡菌除对万古霉素呈敏感外,对其余测试抗菌药物的耐药率均高于80.0%,大肠埃希菌除对亚胺培南耐药率低,为1.1%外,对其余测试抗菌药物的耐药率均高于20.0%。单因素分析和多因素逐步logistic回归分析发现,患者发生医院感染与住院时间、是否机械通气、侵袭性操作、H2受体拮抗剂的使用有关。结论 NICU患者中医院感染发生率高,感染部位集中,影响因素复杂,应采取综合措施控制医院感染,加强病室管理,在治疗及护理过程中应特别注意对呼吸系统和泌尿系统的无菌操作,合理使用抗生素,监测病原菌及其耐药性,减少住院期间的交叉感染等。

Objective To investigate the risk factors of nosocomial infections in neurosurgical intensive care unit （NICU） for better prevention and clinical management of nosocomial infections. Methods A retrospective analysis was conducted in 362 pa tients with nosocomial infections in neurosurgery NICU from January 2008 to May 2010. The data relevant to nosocomial infec- tions were analyzed, including age of patient, site of infection, triggers of infection, pathogens and antibiotic resistance, and possible risk factors. Results Among the 362 patients, the incidence of nosocomial infections was 18.5 , 8.2 cases per 1 000 bed days. The main infection was infection of central nervous system and hospital acquired pneumonia （HAP）, accounting for 58.2o/oo and 34.3/00, respectively. A total of 220 strains of pathogens were identified, 46.8/oo （103/220） of which were gram- negative bacteria, 43.6% （96/220） gram-positive bacteria, and 9.5o/oo （21/220） fungi. More than 80.0o/o of the Staphylococ cus aureus isolates were resistant to all the antibiotics tested except vancomycin. More than 20.0% of the Escherichia coli strains were resistant to all the antibiotics tested except imipenem, to which only 1.1 were resistant. Univariate and muhivari ate logistic regression analysis showed that the main risk factors of hospital infections were the length of hospital stay, mechanical venti- lation, aggressive procedure and use of H2 receptor antagonist. Conclusions The incidence of nosoeomial infection is high in NICU. The infections are mainly found in some body sites with complex risk factors. Environmental management in NICU should be further strengthened. Strict disinfection and isolation measures should be effectively implemented. The aggressive procedures and antimicrobialagents should also be restricted should be taken to monitor the and to reduce cross infections inand to reduce cross infections in hospital.