RICU医院获得性感染病原菌特点与危险因素分析

Distribution of pathogens causing hospital-acquired infections in RICU and analysis of risk factors

目的探讨呼吸科重症监护病房(RICU)住院患者发生医院感染的病原菌分布及危险因素分析,为降低RICU医院感染率提供依据。方法回顾性分析2010年5月-2015年5月医院入住RICU>48h的410例患者临床资料,分析其感染部位、病原菌分布特点及相关危险因素,数据结果采用SPSS 20.0软件进行统计分析。结果 410例RICU患者发生医院感染131例,感染率为31.95%,感染部位主要以下呼吸道62.60%、泌尿道15.27%为主;共检出病原菌195株,其中革兰阴性菌、革兰阳性菌、真菌各占71.28%、18.97%、9.75%;经logistic回归分析发现RICU住院时间≥15d、气管插管、联合使用抗菌药>2种、肺癌是RICU患者发生医院感染的独立危险因素(P<0.05)。结论 RICU住院患者感染部位以下呼吸道为主,病原菌多以革兰阴性菌为主,发生医院感染相关危险因素较多,应采取对应措施,以降低医院感染率。

OBJECTIVE To investigate the distribution of pathogens causing nosocomial infections in hospitalized patients of respiratory intensive care unit（RICU）and analyze the risk factors so as to reduce the incidence of the nosocomial infections in the RICU.METHODS From May 2010 to May 2015,the clinical data of 410 patients who were hospitalized the RICU for more than 48 hours were retrospectively analyzed,then the infection sites,distribution of pathogens,and related risk factors were observed,and the statistical analysis of data was performed with the use of SPSS 20.0software.RESULTS Of the 410 RICU patients,131 had nosocomial infections with the infection rate of 31.95%,of whom 62.60% had lower respiratory tract infections,and 15.27% had urinary tract infections.A total of 195 strains of pathogens were isolated,of which 71.28% were gram-negative bacteria,18.97%were gram-positive bacteria,and 9.75% were fungi.Pseudomonas aeruginosaand Acinetobacter baumannii were the predominant species of the gram-negative bacteria,accounting for 25.64% and 18.97%.The logistic regression analysis indicated that the independent risk factors for the nosocomial infections in the RICU patients included the length of RICU stay no less than 15 days,endotracheal intubation,combination use of more than 2types of antibiotics,and lung cancer（P0.05）.CONCLUSION The patients with lower respiratory tract infections are dominant among the hospitalized RICU patients with the hospital-acquired infections.The gram-negative bacteria are the predominant pathogens.There are a variety of related risk factors for the hospital-acquired infections,and it is necessary to take targeted measures so as to reduce the incidence of the hospital-acquired infections.