上海市活动性类风湿关节炎患者医院感染的流行病学调查

An epidemiological survey of nosocomial infections in Chinese patients with active rheumatoid arthritis in Shanghai

目的调查活动性类风湿关节炎(rheumatoid arthritis,RA)患者医院感染的发生率,致病微生物病原学及临床特征。方法对2009年1月—2011年12月上海市12所医院风湿免疫科收住的2 452例活动性RA患者进行医院感染的前瞻性调查,并对患者人口学及临床特征进行描述。结果共有503例患者(20.51%)发生721例次感染,其中呼吸道感染40.97%、尿路感染22.35%皮肤和软组织感染8.58%。主要致病微生物为常见病原菌(623株,86.40%),包括大肠埃希菌226株(31.35%)、铜绿假单胞菌40株(5.55%)、鲍曼不动杆菌48株(5.42%)、肠球菌属144株(16.25%)和甲氧西林耐药金葡菌(MRSA)15株(2.08%)、甲氧西林耐药凝固阴性葡萄球菌(MRCNS)7株(0.97%),其他为真菌(74株,10.26%)、疱疹病毒(16株,2.21%)和结核分枝杆菌(8株,1.10%)。结论活动性RA患者常见医院感染为呼吸道感染、泌尿生殖道感染和皮肤软组织感染。主要病原菌为大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、葡萄球菌属和肠球菌属等耐药菌。

Objective To investigate the incidence, pathogens and clinical features of nosocomial infections in patients with ac- tive rheumatoid arthritis （RA）. Methods A total of 2 452 active RA patients were reviewed and analyzed retrospectively in Shanghai hospitals between January 2009 and February 2011. The demographic and clinical characteristics were described. Re- suits A total of 721 episodes of infection were found in 503 patients （20.51%）. About 40.97%0 of the infections were of respir atory tract, 22.35% of urinary tract, and 8. 580/00 of skin and soft tissues. Major pathogens were bacteria （623, 86.40%）, in eluding E. cull （226, 31.35/00）, P. aeruginosa （40, 5.55/00）, A. baumannii （48, 5.42）, Enterococcus （144, 16.25/00）, methicillin-resistant Staphylococcus aureus （ 15, 2. 08）, methieillin resistant coagulase-negative Staphylococcus （ 7, 0.97/00）. The other pathogens included fungi （74, 10. 26）, herpes zoster （16, 2.21%）, and Mycobacterium tuberculosis （8, 1. 10%）. Conclusions Nosoeomial infection Js mainly seen in respiratory and urinary tracts, usually associated with E. cu- ll, P. aeruginosa, A. baumanii, methicillin-resistant Staphylococcus and Enterococcus.