重症病毒性肝炎患者医院感染的影响因素分析

Influencing factors for nosocomial infections in patients with severe viral hepatitis

目的分析重症病毒性肝炎患者医院感染病原菌分布及危险因素并研究有效预防对策,为预防与控制重症病毒肝炎患者治疗期间发生医院感染、促进早日康复提供参考依据。方法收集2013年8月-2015年8月医院治疗的246例重症病毒性肝炎患者临床资料,对发生医院感染标本进行病原菌分离培养鉴定,采用K-B法进行药敏试验,分析医院感染与患者性别、年龄、肝硬化、抗菌药物应用、侵入性操作、临床分期及免疫力低下的关系。结果 246例重症病毒性肝炎患者医院感染率33.33%、例次感染率39.02%;共检出136株病原菌,革兰阴性菌79株占58.09%,革兰阳性菌10株占7.35%,真菌47株占34.56%;重症病毒性肝炎患者医院感染部位以呼吸道为主占51.22%,其次为血液占34.15%;重症病毒性肝炎患者医院感染和年龄、肝硬化、抗菌药物应用、侵入性操作及免疫力低下有关(P<0.05)。结论重症病毒性肝炎患者医院感染病原菌分布广泛,应根据相关因素进行合理预防控制。

OBJECTIVE To investigate the distribution of pathogens causing nosocomial infections in patients with severe viral hepatitis,analyze the risk factors,and put forward the effective prevention countermeasures so as to prevent the nosocomial infections in the patients with severe viral hepatitis and promote the early recovery.METHODS The clinical data were collected from 246 patients with severe viral hepatitis who were treated in the hospital from Aug 2013 to Aug 2015.The specimens were obtained from the patients with nosocomial infections,the pathogens were isolated and identified,the drug susceptibility testing was performed by using K-B method,and the relationship between the incidence of nosocomial infections and the genders,age,liver cirrhosis,use of antibiotics,invasive operation,clinical stage,and low immunity was observed.RESULTS Among the 246 patients with severe viral hepatitis,the incidence of nosocomial infections was 33.33%,and the case-time infection rate was 39.02%.A total of 136 strains of pathogens were isolated,including 79（58.09%）strains of gram-negative bacteria,10（7.35%）strains of gram-positive bacteria,and 47（34.56%）strains of fungi.Of the severe viral hepatitis patients with nosocomial infections,51.22% had respiratory tract infections,and 34.15% had blood infections.The incidence of nosocomial infections in the patients with severe viral hepatitis was associated with the age,liver cirrhosis,use of antibiotics,invasive operation,and low immunity（P〈0.05）.CONCLUSION The pathogens causing the nosocomial infections in the patients with severe viral hepatitis are widely distributed,and it is necessary to take effective prevention measures according to the related factors.