肠道真菌医源性感染153例调查与危险因素分析

Investigation and Analysis of Risk Factors for 153 Cases of Nosocomial Intestinal Tract Infection

目的:探讨肠道发生真菌医源性感染的病原种类、相关危险因素,为临床有效预防医源性感染提供参考依据。方法:回顾性调查我院2010年1月至2012年10月发生的肠道真菌医源性感染153例,调查患者的一般资料、治疗方法、用药方案、易感因素、感染的病原菌等相关因素,采用单因素方差分析和多因素Logistic回归分析各因素对肠道真菌感染的危险性。结果:153例患者共检出137株真菌,其中白色念珠菌76株,占55.47%。单因素分析结果显示:年老、长时间联用多种抗菌药物、使用三代头孢菌素和糖皮质激素、营养不良以及基础疾病较严重是发生肠道真菌医源性感染的危险因素(P<0.05),Logistic分析结果显示:联用两种以上抗生素(β=1.879,OR=6.545)、使用三代头孢菌素(β=3.239,OR=25.520)、使用糖皮质激素(β=2.402,OR=11.047)以及严重的基础疾病(β=2.420,OR=11.242)与肠道发生医源性真菌感染密切相关。结论:白色念珠菌是肠道真菌感染的主要致病菌,高龄、不合理应用抗生素和激素以及严重的基础疾病是肠道发生真菌医源性感染的危险因素。

Objective：To investigate the pathogens and risk factors in nosocomial intestinal tract infection patients,in order to make control measurements.Methods：Retrospective investigation method was used to survey the 153 cases of nosocomial infection who were treated in our hospital from January,2010 to October,2012.One-way ANOVA and Multivariate logistic regression were employed to analyze the risk factors,including general information,therapeutics methods,prescriptions and predisposing factors.Results：A total of 137 strains of fungi were checked out from the excrements specimens of the 153 cases.Among them,Blastomyces albicans accounted for 55.47%.One-way ANOVA analysis showed that the old age,associated with a variety of antibiotics for longtime,the use of third generation cephalosporins and glucocorticoid,malnutrition and serious diseases were the risk factors for the intestinal fungal nosocomial infection.Multivariate logistic regression analysis results showed that：the combination of two or more antibiotics（β=1.879,OR=6.545）,use of third generation cephalosporins（β=3.239,OR=25.520）and corticosteroids（β=2.402,OR=11.047）,and serious diseases（β=2.420,OR=11.242）were closely related to the intestinal fungal nosocomial infection.Conclusion：Blastomyces albicans is the main pathogen of intestinal fungal infections,old age,and the irrational use of antibiotics and hormones,as well as the serious underlying disease were the risk factors for the intestinal fungal nosocomial infection.