糖尿病患者医院感染病原菌分布与危险因素分析

Pathogens distribution and risk factors of nosocomial infections in patients with diabetes mellitus

目的探讨糖尿病(DM)并发医院感染患者的病原菌分布及危险因素。方法选择医院2015年9月-2017年2月685例糖尿病患者,分析感染患者的感染率、病原菌分布、药敏特征及感染相关危险因素。结果 685例糖尿病患者共发生医院感染134例,感染率19.56%。感染以呼吸系统、泌尿系统感染为主。共分离174株病原菌,其中,革兰阴性菌102株占58.62%,革兰阳性菌70株占40.23%,真菌2株占1.15%。药敏结果显示,铜绿假单胞菌对亚胺培南敏感率最高为100.00%,对庆大霉素敏感率最低为52.63%。肺炎克雷伯菌对哌拉西林敏感率最高为100.00%,对庆大霉素敏感率最低为54.17%。大肠埃希菌对亚胺培南敏感率最高为95.00%,对氨苄西林敏感率最低为35.00%。金黄色葡萄球菌对苯唑西林敏感率最高为96.15%,对左氧氟沙星敏感率最低为30.77%。粪肠球菌对苯唑西林敏感率最高为100.00%,对青霉素敏感率最低为27.78%。溶血葡萄球菌对万古霉素敏感率最高为100.00%,对青霉素敏感率最低为21.43%。年龄≥60岁、住院时间≥20天、糖化血红蛋白≥9.0%、有侵入性操作、住院前15d内抗菌药物应用是DM并发医院感染的独立危险因素(P<0.05)。结论针对糖尿病并发医院感染的高危因素,加强防控措施以降低感染率。

OBJECTIVE To investigate the pathogens distribution and risk factors of nosocomial infections in patients with diabetes mellitus（DM）.METHODS A total of 685 patients with diabetes from Sep.2015 to Feb.2017 were included in the study.The infection rate,pathogen distribution,drug sensitivity and related risk factors were analyzed.RESULTS There were 134 cases infected among 685 diabetic patients,and the infection rate was19.56%.The respiratory system and urinary system were the main infection sites.Totally 174 strains of pathogenic bacteria were isolated.Among them,there were 102 strains of gram-negative bacteria,accounting for58.62%,70 strains of gram-positive bacteria,accounting for 40.23%,and 2 strains of fungi,accounting for 1.15%.Drug sensitivity test showed that,the sensitive rate of Pseudomonas aeruginosa to imipenem was the highest（100.00%）,and to gentamicin was the lowest（52.63%）.The sensitive rate of Klebsiella pneumoniae to piperacillin was the highest（100.00%）,and to gentamicin was the lowest（54.17%）.The sensitive rate of Escherichia coli to imipenem was the highest（95.00%）,and to ampicillin was the lowest（35.00%）.The sensitive rate of Staphylococcus aureus to oxacillin was the highest（96.15%）,and to levofloxacin was the lowest（30.77%）.The sensitive rate of Enterococcus faecalis to oxacillin was the highest（100.00%）,and to penicillin was the lowest（27.78%）.The sensitive rate of Staphylococcus haemolyticus to vancomycin was the highest（100.00%）,and to penicillin was the lowest（21.43%）.The results showed that,ages≥60 years old,length of stay≥20 days,glycosylated hemoglobin≥9.0%,invasive procedures and use of antimicrobial drugs 15 days before hospitalization were the independent risk factors of nosocomial infections with diabetes mellitus.CONCLUSION The prevention and control measures should be strengthened according to the high risk factors of diabetes complicated with nosocomial infections to reduce the infection rate.