HIV/AIDS死亡病例的医院感染和机会性感染的特征分析

The characteristic analysis of nosocomial infections and opportunistic infections of death cases in HIV/AIDS patients

目的 探讨某院408例HIV/AIDS死亡病例医院感染、机会性感染的特征.方法 对408例HIV/AIDS住院死亡病例进行回顾性分析.结果 某医院HIV/AIDS住院患者4434例,死亡408例,住院病死率9.20％.实行免费抗病毒治疗以来,病死率较前下降.医院感染49例（12.01％）,54例次（13.24％）.病原体最常见的是细菌13例次（24.07％）.常见部位是呼吸、消化系统,分别是20例次（37.04％）、12例次（22.22％）.本组病例医院感染的危险因素分别是合并两个及以上部位的其他机会性感染、住院时间大于30 d、侵袭性操作、使用二联以上抗菌药物、CD4＋T淋巴细胞计数小于200个/μl.98.77％的死亡病例中出现机会性感染1041例次,与死亡直接相关的占81.13％.病原体最常见是真菌393例次（37.75％）,感染部位以肺部、口腔为主,分别是335例次（32.18％）、231例次（22.19％）,其中艾滋病指征性机会性感染334例次（32.08％）.结论 机会性感染（包括医院感染）是HIV/AIDS主要的死亡原因.早期诊断和积极控制机会性感染,防止医院感染,及时有效的HAART治疗是提高HIV/AIDS患者生存质量的关键.

Objective To analyze the characteristics of nosocomial infections （NI） and opportunistic infections （OI） of death cases in HIV/AIDS patients in a hospital. Method A retrospective analysis on a group of 408 HIV/AIDS death cases from Jan 2001 to Dec 2012 was conducted. Results There were 4,434 hospitalized cases with I-IIV/AIDS in a hospital in total and 408 cases died, the fatality rate was 9.20%. Since the introduction of free anti-viral treatment, the fatality rate of HIV/AIDS declined. 49 cases of NI were found among 408 death cases, and the NI rate was 12.01%. Bacteria were the most common pathogens in NI. The most frequent infection sites were respiratory system and digestive system. The risk factors for NI were opportunistic infection of at least two sites, hospital stay over 30 days, invasive operations, CD4~T lymphocyte count lower than 200 ceils/I~ 1 and combination antibiotics administration. There were 1041 cases of OI totally. 81.13% of OI was related to death directly. Fungal infection was the most common in OI. Most of the OI occurred in lung, mouth. The AIDS defining opportunistic infections accounted for 32.08%. Conclusions Opportunistic infections involving nosocomial infections are the most important cause of death. Early diagnosis and treatment for opportunistic infections, preventing and controlling nosocomial infection is the key to improve the life quality of HIV/AIDS patients.