脑卒中患者医院感染病原菌分布及经济损失分析

Distribution of pathogens causing nosocomial infections in stroke patients and economic loss

目的调查脑卒中患者医院感染病原菌分布及经济损失情况,为临床防治措施的制定提供理论依据。方法回顾性分析2013年1月-2015年12月医院收治的296例脑卒中患者的各项临床资料,将发生医院感染的66例患者分为感染组,未发生医院感染的230例患者分为未感染组;分析感染组患者感染部位和病原菌分布,同时分别对比两组患者2013-2015年度的住院费用。结果感染组66例患者共发生医院感染71例次,其中下呼吸道感染最常见,占49.30%,其次为上呼吸道感染,占22.54%;共分离出病原菌71株,其中革兰阴性菌48株占67.61%,革兰阳性菌20株占28.17%,真菌3株占4.23%;革兰阴性菌中铜绿假单胞菌最常见,占52.08%;革兰阳性菌中金黄色葡萄球菌最常见,占40.00%;感染组2013年住院费用(14697.51±2221.56)元、2014年(14018.95±2634.78)元、2015年(13997.58±2467.48)元,均显著高于未感染组(P<0.05)。结论革兰阴性菌是脑卒中患者医院感染的主要致病菌,医院感染的发生可显著增加脑卒中患者的住院费用;临床应加强医院感染的预防控制,有效降低患者的医疗支出。

OBJECTIVE To investigate the distribution of pathogens causing nosocomial infections in stroke patients and analyze the economic loss so as to provide theoretical basis for developing clinical prevention measures. METHODS The clinical data of 296 stroke patients who were treated in the hospital from Jan 2013 to Dec 2015 were retrospectively analyzed, 66 stroke patients with nosocomial infection were assigned as the infection group, and 230 stroke patients without nosocomial infections were set as the non-infection group. The infection sites and distribution of pathogens isolated from the patients of the infection group were observed; the hospitalization cost was compared between the two groups of patients from 2013 to 2015. RESULTS Totally 71 case-times of patients had nosocomial infections among the 66 patients of the infection group; the lower respiratory tract infection was the most common （49. 30%）, followed by the upper respiratory tract infection （22.54%）. A total of 71 strains of pathogens were isolated, including 48 （67.61%） strains of gram-negative bacteria, 20 （28.17%） strains of grampositive bacteria, and 3 （4.23%） strains of fungi. Pseudomonas aeruginosa was the predominant species of gramnegative bacteria,, accounting for 52.08%; Staphylococcus aureus was dominant among the gram-positive bacteria, accounting for 40.00%. The hospitalization cost of the infection group was （14697.51±2221.56） yuan in 2013, （14018.95±2634.78） yuan in 2014, （13997.58±2467.48） yuan in 2015, significantly higher than those of the non-infection group （P〈0.05）. CONCLUSION The gram-negative bacteria are dominant among the pathogens causing the nosocomial infections in the stroke patients, the nosocomial infections may lead to the significance increase of hospitalization cost. It is necessary for the hospital to strengthen the prevention and control of nosocomial infections so as to effectively reduce the medical expense.