毛细支气管炎患儿发生医院感染的病原学及危险因素分析

Analysis on Etiology and Risk Factors of Nosocomial Infections in Children with Bronchiolitis

目的:探讨毛细支气管炎患儿发生医院感染的病原学特征及相关危险因素,以期为临床防治提供依据。方法:选择2013年8月到2015年8月我院收治的发生医院感染的毛细支气管炎患儿324例,检验并分析其病原体分布情况,采用多因素Logistic回归方程分析患儿发生医院感染的危险因素。结果:324例患儿中,病毒感染260例,占80.25%,共检出病毒272株,其中呼吸道合胞病毒(RSV)构成比最高,占47.43%,其他依次是柯萨奇病毒(CBV)占9.93%、鼻病毒(RV)占4.04%、腺病毒(ADV)占3.68%及冠状病毒(COV)占3.31%,其他病毒占31.62%;细菌感染64例,占19.75%,共检出细菌73株,其中大肠埃希菌构成比最高,占41.10%,其他依次是金黄色葡萄球菌占31.51%、肺炎克雷伯菌占17.81%、阴沟肠杆菌占6.85%及不动杆菌属占2.74%。多因素分析结果显示,男性、年龄≤6个月、早产儿、父母患有呼吸道疾病及家庭经济状况差是毛细支气管炎患儿发生医院感染的危险因素(P<0.05)。结论:毛细支气管炎患儿发生医院感染的感染源复杂,临床应对不同性别、年龄、是否早产儿、父母是否患有呼吸道疾病及不同家庭经济状况的患儿进行差别治疗。

Objective： To investigate the pathogenic features and risk factors of nosocomial infection in children with bronchiolitis, so as to provide basis for clinical prevention and treatment. Methods： A total of 324 children with bronchiolitis, who had nosocomial infections in 174th Hospital of PLA, Xiamen during August 2013 to August 2015, were selected. The distribution of pathogens was examined and analyzed, and the risk factors of children with nosocomial infection were analyzed by multiple factor Logistic regression equation. Results： Among the 324 children, 260 cases were infected by virus, accounting for 80.25%. A total of 272 strains of RSV were detected, among which, respiratory syncytial virus （RSV） was the highest, accounting for 47.43%; followed by coxsackie virus （CBV） accounting for 9.93%; rhinovims virus （RV） accounting for 4.04%, adenovirus （ADV） accounting for 3.68%, coronavirus （COV） accounting for 3.31% and others virus accounting for 31.62%. 64 cases had bacterial infection, accounting for 19.75%. A total of 73 strains of bacteria were detected, among which, the proportion of escherichia coli was the highest, accounting for 41.10%, followed by staphylococcusaureus accounting for 31.51%, klebsiella pneumoniae accounting for 17.81%, enterobacter cloacae accounting for 6.85%, and acinetobacter accounting for 2.74%. Multi-factor analysis results showed that males, age≤6 months, premature, parents with respiratory diseases and poor family economic conditions were the risk factors of nosocomial infections in children with bronchiolitis （P〈0.05）. Conclusion： The infection source of nosocomial infection in children with bronchiolitis is complicated, differential treatments should be taken for the children with different gender, age, whether premature, whether parents has respiratory diseases and different family economic conditions in clinical practice.