心内科老年患者医院感染的特点及预防对策

Characteristics of elderly patients with nosocomial infections in cardiology department and prevention countermeasures

目的探讨心内科老年患者医院感染的特点,为制定有效的预防对策提供依据。方法采用回顾性调查方法,对2010年1月-2012年12月心内科患有心力衰竭、急性心肌梗死、心律失常、高血压和心绞痛5类原发疾病的1 748例年龄≥60岁老年患者并发症、侵入性医疗操作、病原学检测结果等进行统计分析。结果发生医院感染218例、245例次,感染率12.5%、例次感染率14.0%;感染部位以呼吸道和泌尿道最多,分别占53.9%和25.7%;感染率最高的原发病是心力衰竭和急性心肌梗死,分别为18.3%和13.7%;分离到病原菌共245株,其中革兰阴性杆菌117株占47.8%,假丝酵母菌属101株占41.2%,革兰阳性球菌27株占11.0%;高龄、患有糖尿病及肺部疾患,接受机械通气≥48h、留置导尿≥48h、住院≥21d及使用抗菌药物≥7d等是发生医院感染的相关因素。结论根据老年患者的特点,采取综合性预防措施、积极治疗原发疾病、控制侵入性操作等,有助于降低医院感染发病率。

OBJECTIVE To explore the characteristics of the elderly patients with nosocomial infections in cardiolo-gy department so as to put forward effective prevention countermeasures .METHODS By means of retrospective survey ,from Jan 2010 to Dec 2012 ,totally 1 748 elderly patients aged no less than 60 years old who suffered from five primary disease such as heart failure ,acute myocardial infarction ,cardiac arrhythmias ,hypertension ,and an-gina pectoris were enrolled in the study ,then the complications ,invasive medical operations ,and results of etio-logical examination were statistically analyzed .RESULTS The nosocomial infections occurred in 218 （245 case-times） cases with the infection rate of 12 .5% and the case-time infection rate of 14 .0% ,among whom the 53 .9%were the respiratory tract infections and 25 .7% were the urinary tract infections .Among the patients with the pri-mary diseases ,the incidence rates of infections were highest in the patients with heart failure （18 .3% ） and the pa-tients with acute myocardial infarction （13 .7% ） .A total of 245 strains of pathogens have been isolated ,including 117 （47 .8% ） strains of gram-negative bacilli ,101 （41 .2% ） strains of Candida spp ,and 27 （11 .0% ） strains of gram-positive cocci .The advanced age ,complication of diabetes or pulmonary diseases ,mechanical ventilation du-ration no less than 48 hours ,catheter indwelling time no less than 48 hours ,length of hospital stay no less than 21 days ,and time of use of antibiotics no less than 7 days were the related factors for the nosocomial infections . CONCLUSION It is an effective way to take comprehensive prevention measures according to the characteristics of the elderly patients ,actively treat the primary diseases ,and control the invasive operations so as to reduce the in-cidence of nosocomial infections .