影响肾病综合征患儿医院感染的危险因素分析

Risk factor of hospital infection in children with nephrotic syndrome

目的探究影响肾病综合征患儿医院感染的危险因素,探讨有效的预防措施。方法选取2011年9月至2014年9月在本院接受治疗的肾病综合征患儿98例,其中有20例发生医院感染,分析患儿的感染率、感染病菌和感染部位。比较未感染组和感染组患儿的临床资料,用单因素分析和Logistic回归分析其影响因素。结果 98例患儿中共20例发生医院感染,感染发生率为20.41%,病原菌主要为流感嗜血菌、肺炎克雷伯菌和大肠埃希菌,构成比分别为16.83%、20.79%和42.08%。感染部位主要是呼吸道和泌尿道,构成比分别为45.00%和20.00%。肾病综合征患儿患医院感染与激素使用时间、住院时间、病程、感染前是否应用抗菌药物、24 h尿蛋白量、血浆白蛋白水平有关(P<0.05)。将上述因素纳入Logistic多元回归分析,显示激素使用时间、住院时间、感染前是否应用抗菌药物、24 h尿蛋白量、血浆白蛋白水平是肾病综合征患儿患医院感染的危险因素(P<0.05)。结论激素使用时间长、住院时间长、感染前应用抗菌药物、24 h尿蛋白量高、血浆白蛋白水平低是肾病综合征患儿患医院感染的危险因素。提高患者自身免疫力,合理使用抗菌药物是预防医院感染的关键。

Objective To explore the risk factor of hospital infection in children with nephrotic syndrome and effective preventive measures. Methods A total of 98 children with nephrotic syndrome were chosen to receive treatment in our hospital between September 2011 and September 2014. Among them, 20 had hospital infection. The infection rate, infection germs and infection part of the patients were analyzed. Clinical data were compared between the uninfected and the infected-group, and single factor analysis and Logistic regression were used to analyze its influencing factors. Results Out of the 98 children, 20 had nosocomial infection（incidence of infection 20.41%）. The pathogenic bacteria were mainly flu bloodthirsty bacteria, klebsiella pneumoniae and E. Coli（16.83%, 20.79% and 42.08%, respectively）. The infection part was mainly respiratory and urinary tract（45.00% and 20.00% respectively）. Hospital infection in children with nephrotic syndrome was related to the time of hormone use, duration of hospital stay, infection before the administration of antimicrobial agents, 24 h urine protein quantity, and plasma albumin levels（P〈0.05）. Logistic multivariate regression analysis of the above factors showed that time of hormone use, length of hospital stay, whether infection before the application of antimicrobial agents, 24 h urine protein quantity and plasma albumin levels were all risk factors of hospital infection in children with nephrotic syndrome（P〈0.05）. Conclusion Length of hormone use and hospital stay, infection before the administration of antimicrobial agents, 24 h high volume urine protein, and low plasma albumin levels are risk factors of hospital infection in children with nephrotic syndrome. Improving child patients＇ immune system and rational use of antimicrobial agents are the keys to preventing hospital infection.