呼吸内科患者医院感染特点及危险因素分析

Characteristics and risk factors for nosocomial infections in patients of respiratory medicine department

目的分析呼吸内科患者医院感染特点,制定有效的医院感染预防与控制措施。方法选择2016年1月1日-2016年12月31日入住呼吸内科的3083例患者作为研究对象,采用查阅患者住院病历的方法,进行回顾性调查。调查内容包括医院感染患者的感染部位、抗菌药物使用情况、病原学送检及检出情况、医院感染相关影响因素等。结果本次共调查患者3083例,医院感染率为3.47%;感染部位以呼吸道感染为主;抗菌药物使用率为85.79%;治疗性使用抗菌药物的病原学送检率为81.64%;医院感染病原菌种类以革兰阴性菌为主,共检出110株,占74.83%,其次为真菌,32株,占21.77%;革兰阴性菌中主要包括鲍氏不动杆菌53株,铜绿假单胞菌14株;抗菌药物的使用方面,左氧氟沙星与哌拉西林他唑巴坦使用占比最高,分别为26.35%和13.59%;经logistic回归模型分析,年龄、非感染肺疾病、抗菌药物使用、留置导尿管、动静脉插管、使用呼吸机是发生医院感染的独立危险因素。结论呼吸内科发生医院感染患者的感染管理指标具有独特性,主要以呼吸系统感染为主,抗菌药物的使用率较高。应通过对患者进行健康宣教、严格执行医院感染预防控制制度、合理使用抗菌药物、规范探视陪护人员管理、加强对医护人员院感预防控制知识的培训力度等一系列措施来有效减少医院感染的发生。

OBJECTIVE To investigate the characteristics of nosocomial infections in patients of respiratory medicine department and put forward the effective prevention and control measures.METHODS A total of 3083 patients who were hospitalized the respiratory medicine department from Jan 1,2016 to Dec 31,2016 were recruited as the study objects,the retrospective survey was conducted by means of review of medical records of the hospitalized patients,and the survey contents included the infection sites,status of use of antibiotics,etiological submission and isolation and influencing factors for nosocomial infections.RESULTS Totally 3083 patients were investigated,and the incidence rate of nosocomial infection was 3.47% .The respiratory tract was the major infection site.The utilization rate of antibiotics was 85.79% .The etiological submission rate of the therapeutic use of antibiotics was81.64% .The gram-negative bacteria were dominant among the pathogens causing the nosocomial infections,accounting for 74.83% （110strains）,followed by the fungi（32strain,21.77% ）.Among the gram-negative bacteria,there were 53 strains of Acinetobacter baumannii and 14 strains of Pseudomonas aeruginosa.In the view of the use of antibiotics,the patients who used levofloxacin accounted for 26.35% ,and the patients who used piperacillin-tazobactam accounted for 13.59% .The logistic regression model analysis showed that the independent risk factors for the nosocomial infections included the age,non-infectious pulmonary diseases,use of antibiotics,urinary catheter indwelling,arteriovenous intubation and use of ventilators.CONCLUSION The respiratory medicine department patients with the nosocomial infections show peculiar characteristics of infection control indexes,the respiratory system is the major infection site,and the utilization rate of antibiotics is high.It is necessary to conduct the health education,rigidly execute the prevention and control system for nosocomial infections,reasonably use antibiotics,standardize the management of visiting and accompanying personnel and boost the training of prevention and control knowledge of nosocomial infections of health care workers so as to effectively reduce the incidence of nosocomial infections.