糖尿病患者医院感染的影响因素分析

Influencing factors for concurrent nosocomial infections in patients with diabetic mellitus

目的探讨糖尿病患者发生医院感染的相关影响因素,为预防糖尿病患者医院感染的发生提供科学依据。方法选取2011年12月-2013年12月在内分泌科住院的糖尿病患者1 329例进行回顾性分析,采集并记录患者的年龄、性别、文化程度、病程、住院时间、24h尿糖定量、血清白蛋白、空腹血糖、DM并发症(酮症酸中毒、周围神经病变和高渗性昏迷等)、是否应用抗菌药物以及有无侵入性操作(气管插管、留置导尿、深静脉插管等)等,统计分析采用χ2检验、非条件logistic回归分析。结果 1 329例糖尿病患者发生医院感染316例,感染率23.78%,感染部位以呼吸道感染最多占55.69%,其次是泌尿道占31.33%;单因素分析显示,不同文化程度、病程、住院时间、24h尿糖定量、血清白蛋白、空腹血糖、应用抗菌药物和行侵入性操作的糖尿病患者医院感染的发生率,差异均有统计学意义(P<0.05);多因素logistic回归分析表明,住院时间≥4周、24h尿糖定量≥15g、血清白蛋白<35g/L、空腹血糖≥8.00mmol/L、应用抗菌药物和侵入性操作是糖尿病患者合并医院感染的危险因素。结论为预防糖尿病患者合并医院感染,应关注血糖控制不佳、住院时间长、高尿糖定量、低蛋白血症、应用抗菌药物以及有侵入性操作的患者。

OBJECTIVE To explore the influencing factors for nosocomial infections in the patients with diabetic mellitus so as to provide scientific basis for prevention of nosocomial infections in the patients with diabetic melli-tus.METHODS A total of 1 329 patients with diabetic mellitus who were hospitalized the department of endocrinol-ogy from Dec 2011 to Dec 2013 were enrolled in the study;the age,genders,education levels,disease courses, length of hospital stay,24-hour urine quantitative,serum albumin,blood glucose,complication of DM （Ketoaci-dosis,peripheral neuropathy,and hyperosmolar coma）,use of antibiotics,and invasive operations （endotracheal intubation,urinary catheter indwelling,deep venous catheter indwelling ）were collected and recorded,and the statistical analysis was performed through the chi-square test and the non-conditional logistic regression analysis. RESULTS The nosocomial infections occurred in 316 of 1329 diabetic mellitus patients with the infection rate of 23.78%, among whom the patients with respiratory tract infections accounted for 5 5 .6 9%,the patients with urinary tract infec-tions 3 1 .3 3%.The univariate analysis indicted that there was significant difference in the incidence of nosocomial infec-tions between the patients with difference education levels,disease courses,length of hospital stay,24-hour urine quanti-tative,serum albumin levels,blood glucose levels,use of antibiotics,or invasive operations （P〈0.05）.The multivariate logistic regression analysis showed that the length of hospital stay no less than 4 weeks,24-hour urine quantitative no less than 15 g,serum albumin level less than 35 g/L,blood glucose level no less than 8.00 mmol/L,use of antibiotics,and invasive operations were the risk factors for the concurrent nosocomial infections in the patients with diabetic mellitus. CONCLUSION It is necessary to focus on the patients with poor control of blood glucose,long length of hospital stay,high urine quantitative,low level of serum albumin,use of antibiotics,or invasive operations so as to pre-vent the concurrent nosocomial infections in the patients with diabetic mellitus.