脊髓损伤患者康复期医院感染特点与相关因素分析

Characteristics of nosocomial infections in patients with spinal cord injury during rehabilitation stage and analysis of related factors

目的研究脊髓损伤患者在康复期发生医院感染的特点及危险因素,为临床降低感染率寻求应对方向。方法回顾性分析2010年1月-2013年7月426例脊髓损伤患者的临床资料,统计分析感染患者的医院感染率、病原菌分布特点、感染部位分布,并对患者性别、年龄、既往病史、治疗过程、体征特点、损伤状况等相关因素实施单因素及多因素非条件回归分析;采用SPSS11.7软件进行统计分析。结果 426例患者康复期发生医院感染129例,感染率30.28%;感染部位以泌尿系统和呼吸系统为主,分别占42.6%和31.8%;共培养出病原菌183株,以革兰阴性菌为主,前3位病原菌依次为铜绿假单胞菌、大肠埃希菌、表皮葡萄球菌,分别占51.9%、33.9%和7.1%;脊髓完全损伤程度、低蛋白血症、侵入性操作史、抗菌药物应用等均为脊髓损伤患者康复期医院感染的危险因素(P<0.05)。结论脊髓损伤患者常见医院感染部位为泌尿系统及呼吸系统,感染病原菌以革兰阴性菌为主,临床应针对医院感染的危险因素进行相应干预,以提高患者生存质量。

OBJECTIVE To investigate the characteristics of nosocomial infections in the patients with spinal cord injury during the rehabilitation stage and explore the risk factors so as to seek the corresponding measures for reduction of incidence of the infections.METHODS The clinical data of 426 patients with spinal cord injury from Jan2010 to Jul 2013 were retrospectively analyzed.The incidence of the nosocomial infections,distribution of pathogens,and distribution of infection sites were statistically analyzed.The univariate analysis and the non-conditional multivariate regression analysis were performed for the related factors including the genders,age,past medical history,treatment process,features of sings,and condition of injury.The statistical analysis was carried out by using SPSS 11.7software.RESULTS The nosocomial infections occurred in 129 of 426patients during the rehabilitation stage,with the infection rate of 30.28%.Of the 129 patients with nosocomial infections,42.6% had the urinary system infections,and 31.8% had the respiratory system infections.A total of 183 strains of pathogens were isolated,among which the gram-negative bacteria were dominant;the Pseudomonas aeruginosa,Escherichia coli,and Staphylococcus epidermidis ranked the top 3species of pathogens,accounting for 51.9%,33.9%,and7.1%,respectively.The risk factors for the nosocomial infections in the spinal cord injury patients during the rehabilitation stage included the degree of complete spinal cord injury,hypoproteinemia,history of invasive operation,and use of antibiotics（P〈0.05）.CONCLUSIONThe urinary system and respiratory system are the common nosocomial infection sites of the patients with spinal cord injury.The gram-negative bacteria are dominant among the pathogens causing the infection.It is necessary for the hospital to take targeted interventions in response to the risk factors for the nosocomial infections so as to improve the quality of life of the patients.