肾病科患者医院感染危险因素分析

Risk factors for nosocomial infections in patients of nephrology department

目的探索肾病科医院感染的相关危险因素及病原菌分布,为控制感染提供依据。方法对2010年1月-2014年6月肾病科11 389例患者的临床资料进行回顾性调查,应用单因素分析和多因素logistic回归分析对感染危险因素进行分析,采用SPSS17.0软件对数据进行统计分析。结果肾病科11 389例患者发生医院感染344例、391例次,感染率3.02%、例次感染率3.43%;感染部位以下呼吸道感染为主,占43.99%;共检出病原菌309株,革兰阴性菌136株占44.02%,革兰阳性菌84株占27.18%,真菌89株占28.80%;单因素分析显示,体质量较低、介入史、年龄偏高、高血压、糖尿病、尿毒症、慢性肾功能不全、肾病综合征、总住院天数、入住ICU、中心静脉置管、使用呼吸机及留置尿管等与医院感染的发生存在密切的相关性(P<0.05);多因素logistic回归分析结果显示,体质量较低、入住ICU、住院时间长、患有高血压、肾病综合征、使用呼吸机、中心静脉置管及留置尿管是医院感染发生的独立危险因素(P<0.05)。结论在临床工作中,针对危险因素采取相应控制措施,以预防与控制医院感染的发生。

OBJECTIVE To explore the related risk factors for nosocomial infections in the nephrology department and observe the distribution of pathogens so as to provide guidance for the control of nosocomial infections . METHODS A retrospective survey was conducted to investigate the clinical data of 11 389 patients who were trea‐ted in the nephrology department from Jan 2010 to Jun 2014 ,the risk factors for the nosocomial infections were analyzed by means of univariate analysis and multivariate logistic regression analysis ,and the statistical analysis was performed with the use of SPSS17 .0 software .RESULTS The nosocomial infections occurred in 344 （391 case‐times）of 11 389 patients with the infection rate of 3 .02% and the case‐time infection rate of 3 .43% ,of whom 43 .99% had the lower respiratory tract infections .A total of 309 strains of pathogens have been isolated ,including 136 （44 .02% ） strains of gram‐negative bacteria , 84 （27 .18% ） strains of gram‐positive bacteria , and 89 （28 .80% ） strains of fungi .The univariate analysis showed that the incidence of nosocomial infections was closely associated with the low body mass index ,interventional operation history ,old age ,hypertension ,diabetic melli‐tus ,uremia ,chronic renal dysfunction ,nephrotic syndrome ,total length of hospital stay ,ICU stay ,central ve‐nous catheter indwelling ,use of ventilator ,and urinary catheter indwelling （P〈0 .05）;the multivariate logistic regression analysis indicated that the low body mass index ,ICU stay ,long length of hospital stay ,hypertension , nephrotic syndrome ,use of ventilator ,central venous catheter indwelling ,and urinary catheter indwelling were the independent risk factors for the nosocomial infections （P〈0 .05） .CONCLUSION In the clinical practice ,it is necessary to take targeted control measures aiming at the risk factors so as to prevent the nosocomial infections .