慢性重型乙型肝炎患者医院感染特点及危险因素

Characteristics and risk factors for healthcare-associated infection in patients with severe chronic hepatitis B

目的探讨慢性重型乙型肝炎患者医院感染的临床特点及危险因素,为预防与控制其医院感染的发生提供理论依据。方法采用回顾性调查方法,调查某院2012年1月—2015年1月的慢性重型乙型肝炎住院患者的医院感染发生情况,并对其医院感染的危险因素进行分析。结果共调查126例慢性重型乙型肝炎患者,发生医院感染49例,106例次,医院感染发病率为38.89%。医院感染部位以呼吸道为主(47例次,占44.34%),其次为腹腔(34例次,占32.08%)。共检出医院感染病原菌76株,其中革兰阴性菌41株(53.95%),革兰阳性菌33株(43.42%),真菌2株(2.63%)。患者年龄≥60岁、住院日数≥30 d、合并并发症、侵袭性操作、血清清蛋白<35 g/L、白细胞<4×109/L是慢性重型乙型肝炎患者发生医院感染的危险因素。结论慢性重型乙型肝炎患者医院感染发病率较高,以呼吸道及腹腔感染为主,年龄较大、住院时间长、侵袭性操作、低蛋白血症及血白细胞低均是其医院感染的危险因素。

Objective To investigate the clinical characteristics and risk factors for healthcare-associated infection （HAI）in patients with severe chronic hepatitis B （CHB）,and provide theoretical basis for preventing and controlling HAI.Methods Retrospective survey was used to investigate the occurrence of HAI in hospitalized patients with severe CHB in a hospital between January 2012 and January 2015,risk factors for HAI were analyzed. Results A total of 126 patients with severe CHB were investigated,49 patients developed 106 times of HAI, incidence of HAI was 38.89%.The main HAI site was respiratory tract （n=47,44.34%）,the next was abdominal cavity （n=34,32.08%）.A total of 76 isolates of pathogens were detected,gram-negative bacteria,gram-positive bacteria,and fungi accounted for 53.95%（n =41 ）,43.42%（n =33）,and 2.63%（n =2）respectively.Risk factors for HAI in patients with severe CHB were patients ’ age ≥ 60 years, length of hospital stay ≥ 30 days, complications,invasive operation,serum albumin ＆lt; 35 g/L,and white blood cell count （WBC）＆lt; 4 ±10^9/L. Conclusion Incidence of HAI in patients with severe CHB is high,the majority are respiratory tract and abdominal cavity infection,risk factors are old age,long length of hospital stay,invasive operation,hypoalbuminemia,and low WBC count.