老年住院患者医院感染影响因素与预警指标研究

Investigation on risk factors and early-warning markers for nosocomial infections in aged inpatients

目的研究老年住院患者医院感染现况,分析可能的影响因素并探讨血液实验室检查指标在细菌感染中的预警价值。方法选择医院2015-2016年年龄≥60岁老年住院患者4 795例为研究对象,发生医院感染79例,按照1∶1配对法分为病例组及对照组,各79例,分析其感染因素及预警指标。结果共79例发生医院感染,96例次感染,感染率为1.65%,例次感染率为2.00%;感染部位以呼吸道为主,共33例次,占34.38%;检出72株病原菌,以革兰阴性菌为主,共43株占59.72%;GLU和NLR是发生医院感染的独立危险因素(P<0.05);NLR用于老年住院患者医院感染预警的界值为4.39,对应的灵敏度为79.75%,特异度为74.68%。结论老年医院感染病例需要关注高龄人群,积极监测并防控感染相关因素,NLR对于老年住院患者医院感染具有较好的预警意义。

OBJECTIVE To investigate the current status and analyze the risk factors for nosocomial infections in aged inpatients and to explore the early-warning value of laboratory test indexes of blood in diagnosis of bacterial infections in aged inpatients.METHODS From Jan.2015 to Dec.2016,4795 cases of inpatients older than 60 years old from a tertiary hospital in Beijing were selected as research object,of which 79 cases occurred nosocomial infections.Additional individual paired case-control study was designed,with 79 cases in control group.The risk factors and early-warning markers for nosocomial infection were analyzed.RESULTS A total of 79cases（96times）of nosocomial infections were detected,with the infection rate of 1.65%and the case-time infection rate of2.00%.The major infections site was lower respiratory tract（33times）,accounting for 34.38%.A total of 72 strains of pathogenic bacteria were detected,which were mainly gram-negative bacteria（43strains）,accounting for 59.72%.GLU and NRL were independent risk factors for nosocomial infections.The cut-off value of NLR for early-warning of nosocomial infection in aged inpatients was 4.39,and the sensitivity and specificity were respectively 79.75% and 74.68%.CONCLUSION The aged hospitalized patients are at high risk of nosocomial infections,and it is necesary to actively monitor and control infection-related factors.NLR has a good early-warning significance for nosocomial infections in aged inpatients.