NSTE-ACS老年患者医院感染的病原学和影响因素分析

Influencing factors and etiological characteristics of nosocomial infection in elderly patients with NSTE-ACS

目的观察非ST段抬高性急性冠状动脉综合征(NSTE-ACS)老年患者医院感染发生情况,探究发生医院感染的影响因素,分析感染患者病原学特点,为临床NSTE-ACS老年患者预防医院感染提供指导。方法收集2013年8月-2016年8月经医院治疗的140例NSTE-ACS老年患者为研究对象,回顾性分析患者临床资料,单因素及多因素Logistics回归分析患者发生医院感染的影响因素。采集感染患者临床标本进行病原学分析。结果 140例NSTE-ACS老年患者共发生医院感染17例,感染率为12.14%,其中呼吸道感染10例占58.82%。17例感染患者共检出病原菌28株,其中革兰阴性菌14株占50.00%。多因素Logistics回归分析显示患者年龄≥70岁、患有糖尿病、慢性阻塞性肺疾病、高血压、Killip心功能分级3-4级以及住院时间≥14d是NSTE-ACS老年患者发生医院感染的独立影响因素(P<0.05)。结论 NSTE-ACS老年患者医院感染主要病原菌是革兰阴性菌,高龄、合并糖尿病、合并慢性阻塞性肺疾病、合并高血压、高killip心功能分级、较长住院时间等是NSTEACS老年患者发生医院感染的高危因素。

OBJECTIVE To investigate the prevalence of nosocomial infection in elderly patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS),explore the influencing factors for nosocomial infection and analyze the etiological characteristics of the patients with infection so as to provide guidance for prevention of nosocomial infection in the elderly patients with NSTE-ACS.METHODS A total of 140 elderly patients with NSTE-ACS who were treated in hospitals from Aug 2013 to Aug 2016 were recruited as the study objects,the clinical data of the patients were retrospectively analyzed,univariate analysis and multivariate logistic regression analysis were performed for the influencing factors for the nosocomial infection,and the clinical specimens that were collected from the patients with infection were cultured for etiological analysis.RESULTS Of the 140 elderly patients with NSTE-ACS,17 had nosocomial infection,with the infection rate 12.14%,10(58.82%)of whom had respiratory tract infection.Totally 28 strains of pathogens were isolated from the 17 patients with the infection,14(50.00%)of which were gram-negative bacteria.The multivariate logistic regression analysis indicated that the no less than 70 years of age,diabetes mellitus,chronic obstructive pulmonary disease,hypertension,grade 3-4 Killip cardiac function and length of hospital stay no less than 14 days were the independent influencing factors for the nosocomial infection in the elderly patients with NSTE-ACS(P<0.05).CONCLUSION The gramnegative bacteria are dominant among the pathogens causing the nosocomial infection in the elderly patients with NSTE-ACS.The advanced age,diabetes mellitus,chronic obstructive pulmonary disease,hypertension,high grade Killip cardiac function and long length of hospital stay are the high risk factors for the nosocomial infection in the elderly patients with NSTE-ACS.