肾脏内科住院患者医院感染的危险因素分析

Risk factors for nosocomial infections in hospitalized paitents of nephrology department

目的探讨肾脏内科住院患者医院感染的危险因素,为临床预防及治疗提供参考。方法选取2015年4月-2016年5月浙江省荣军医院肾内科住院患者320例,详细记录患者性别、年龄、肾脏基础疾病、实验室检查结果、感染部位、感染时长等情况,并对患者进行相关病原学检查。结果 320例住院患者中,发生医院感染78例,医院感染发生率24.38%,其中糖尿病肾病患者医院感染15例,慢性肾炎患者医院感染11例,系统性红斑狼疮患者医院感染2例,肾病综合征患者医院感染12例,尿毒症透析患者医院感染38例;感染类型结果显示,呼吸道感染34例,胃肠道感染8例,尿路感染10例,皮肤及软组织感染6例,置管感染20例;病原学结果显示,检出革兰阳性菌39株,革兰阴性菌37株,真菌2株;感染组与非感染组在年龄、透析、住院时间、血肌酐、血浆白蛋白方面差异有统计学意义(P<0.05);肾内科住院患者年龄大、白蛋白水平低、住院时间≥30d是医院感染发生的独立危险因素。结论肾内科住院患者中透析患者是医院感染率较高群体,其中呼吸道感染以及置管感染为多发医院感染类型,而医院感染的发生与高龄、住院时间过长、白蛋白水平较低呈正相关。

OBJECTIVE To explore the risk factors for nosocomial infections in hospitalized patients of nephrology department so as to provide guidance for clinical prevention and treatment.METHODS A total of 320 patients who were hospitalized the department of nephrology of Rongjun Hospital,Zhejiang Province from Apr 2015 to May2016were enrolled in the study.The data of the patients,including gender,age,renal underlying diseases,results of clinical laboratory tests,infection sites,and length of infection,were recorded in detail.The related etiological examinations were carried out for the patients.RESULTS Of the 320 hospitalized patients,78 had nosocomial infections,with the incidence of nosocomial infection 24.38%,of whom 15 had diabetic nephropathy,11 had chronic nephritis,2had systemic lupus erythematosus,12 had nephrotic syndrome,and 38 had uremia and received dialysis.The result of types of infections indicated that there were 34 cases of respiratory tract infection,8cases of gastrointestinal tract infection,10 cases of urinary tract infection,6cases of skin and soft tissue infection,and 20 cases of catheter-related infection.The results of the etiological examinations showed that among the isolated pathogens,there were 39 stains of gram-positive bacteria,37 stains of gram-negative bacteria,and 2strains of fungi.There was significant difference in the age,dialysis,length of hospital stay,serum creatinine level,or plasma albumin between the infection group and the non-infection group（P〈0.05）.The advanced age,low albumin level,and length of hospital stay no less than 30 days were the independent risk factors for the nosocomial infections in the hospitalized patients of nephrology department.CONCLUSION Among the hospitalized patients of nephrology department,the incidence of nosocomial infection is relatively high in the dialysis patients,and the patients with respiratory tract infection and the patients with catheter-related infection are dominant among the patients with the nosocomial infections.The incidence of the nosocomial infection is positively correlated with the advanced age,long length of hospital stay,and low level of albumin.